Provider Demographics
NPI:1942587969
Name:NA, HYUN KYUNG
Entity Type:Individual
Prefix:
First Name:HYUN KYUNG
Middle Name:
Last Name:NA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HYUN KYUNG
Other - Middle Name:
Other - Last Name:OH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:80 RICHMOND HILL RD APT 3H
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-7807
Mailing Address - Country:US
Mailing Address - Phone:347-209-7307
Mailing Address - Fax:
Practice Address - Street 1:80 RICHMOND HILL RD APT 3H
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-7807
Practice Address - Country:US
Practice Address - Phone:347-209-7307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY620856163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPM17244AMedicaid