Provider Demographics
NPI:1508614918
Name:KIM, SONGYEON (APRN)
Entity Type:Individual
Prefix:
First Name:SONGYEON
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 N WACO AVE STE 570
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-3986
Mailing Address - Country:US
Mailing Address - Phone:316-295-3015
Mailing Address - Fax:
Practice Address - Street 1:727 N WACO AVE STE 570
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-3986
Practice Address - Country:US
Practice Address - Phone:316-295-3015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-09
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-83196-112363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily