Provider Demographics
NPI:1275275125
Name:KIM, SARAH SHIN YOUNG (NP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:SHIN YOUNG
Last Name:KIM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 PARK AVE APT 2201
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-3776
Mailing Address - Country:US
Mailing Address - Phone:818-521-2193
Mailing Address - Fax:
Practice Address - Street 1:800 PARK AVE APT 2201
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-3776
Practice Address - Country:US
Practice Address - Phone:818-521-2193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01297700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily