Individual
TAESEONG KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
259 1ST ST # ER, MINEOLA, NY 11501-3957
(516) 663-2201
Mailing address
259 1ST ST # ER, MINEOLA, NY 11501-3957
(516) 663-2201
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
432762
NY
363LF0000X
Family Nurse Practitioner
346753
NY
Other
Enumeration date
11/06/2020
Last updated
10/23/2023
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