Provider Demographics
NPI:1851790315
Name:KIM-AMARO, KAB JU (NP)
Entity Type:Individual
Prefix:
First Name:KAB JU
Middle Name:
Last Name:KIM-AMARO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KAB JU
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:701 W 177TH ST
Mailing Address - Street 2:43
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-6928
Mailing Address - Country:US
Mailing Address - Phone:347-426-7513
Mailing Address - Fax:
Practice Address - Street 1:625 E FORDHAM RD
Practice Address - Street 2:MEDICINE CLINIC
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5049
Practice Address - Country:US
Practice Address - Phone:718-933-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF338690363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily