Provider Demographics
NPI:1801128053
Name:KIM, KYUNGAE (PMHNP-BC (PSYCHATRIC)
Entity type:Individual
Prefix:MRS
First Name:KYUNGAE
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:PMHNP-BC (PSYCHATRIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WOODS AVE VALHALLA CAMPUS
Mailing Address - Street 2:WESTCHESTER MEDICAL CENTER
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595
Mailing Address - Country:US
Mailing Address - Phone:914-493-7000
Mailing Address - Fax:914-493-2978
Practice Address - Street 1:100 WOODS AVE
Practice Address - Street 2:WESTCHESTER MEDICAL CENTER-BEHAVIOR HEALTH CENTER
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595
Practice Address - Country:US
Practice Address - Phone:914-493-7000
Practice Address - Fax:914-493-1015
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-12
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY459153163W00000X
NYF401414-1/7534679363LP0808X
NY459153-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse