Provider Demographics
NPI:1619689007
Name:KIM, MISUNG
Entity type:Individual
Prefix:
First Name:MISUNG
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 1:836 PALISADE AVE
Mailing Address - Street 2:APT 6H
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-1539
Mailing Address - Country:US
Mailing Address - Phone:213-245-8213
Mailing Address - Fax:
Practice Address - Street 1:836 PALISADE AVE
Practice Address - Street 2:APT 6H
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703-1539
Practice Address - Country:US
Practice Address - Phone:213-245-8213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY347355363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily