Provider Demographics
NPI:1154632941
Name:KIM, YEESOON
Entity type:Individual
Prefix:
First Name:YEESOON
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7536 BELL BLVD
Mailing Address - Street 2:3E
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-3455
Mailing Address - Country:US
Mailing Address - Phone:718-464-9523
Mailing Address - Fax:
Practice Address - Street 1:7536 BELL BLVD
Practice Address - Street 2:3E
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-3455
Practice Address - Country:US
Practice Address - Phone:718-464-9523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-25
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY348408163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool