Provider Demographics
NPI:1922516871
Name:LI-AH-KIM, MIN-MIN (FNP)
Entity Type:Individual
Prefix:
First Name:MIN-MIN
Middle Name:
Last Name:LI-AH-KIM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 ROUTE 517
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-2708
Mailing Address - Country:US
Mailing Address - Phone:908-852-0107
Mailing Address - Fax:
Practice Address - Street 1:1575 ROUTE 517
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2708
Practice Address - Country:US
Practice Address - Phone:908-852-0107
Practice Address - Fax:908-850-9160
Is Sole Proprietor?:No
Enumeration Date:2018-01-12
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00792400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily