Individual
EVA KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1430 BROADWAY, LONG ISLAND CITY, NY 11106-4530
(929) 656-3407
Mailing address
1430 BROADWAY, LONG ISLAND CITY, NY 11106-4530
(929) 656-3407
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
26NJ01217100
NJ
363LP0200X
Pediatric Nurse Practitioner
Primary
383506
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1528721586
—
NY
Enumeration date
10/18/2021
Last updated
03/24/2026
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