Individual
JISUN KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
111 E 210TH ST, BRONX, NY 10467-2401
(718) 920-4321
Mailing address
3225 JOHNSON AVE APT 5A, BRONX, NY 10463-3517
(646) 712-0442
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
11/28/2017
Last updated
11/28/2017
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