Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 309261 | NY |
NPI | 1013562891 |
---|---|
Provider Name | Ms. Haksoo Kim |
First Address | Melville, NY 11747-4113 |
Second Address | Melville, NY 11747-4113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2019 |
Last Update Date | 07/08/2019 |