Provider Demographics
NPI:1104534213
Name:KIM, HYUNJOO (APN)
Entity type:Individual
Prefix:
First Name:HYUNJOO
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 SHINNECOCK DR
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-9507
Mailing Address - Country:US
Mailing Address - Phone:732-447-8253
Mailing Address - Fax:
Practice Address - Street 1:151 SHINNECOCK DR
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-9507
Practice Address - Country:US
Practice Address - Phone:732-447-8253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01357100363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner