Individual
JIYON JENNIFER KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.A.-C., MPAS
Contact information
Practice address
727 BROADWAY, SUITE B4, MASSAPEQUA, NY 11758
(516) 799-0210
(516) 799-6569
Mailing address
755 PARK AVE, STE 500, HUNTINGTON, NY 11743-3979
(631) 271-2769
(631) 271-1730
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
006956
NY
Other
Enumeration date
11/02/2006
Last updated
05/14/2019
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