Kim, Sun Ja

Kim, Sun Ja is an individual health care provider with primary practice located at 7901 Broadway Managed Care, D1-01, Elmhurst NY 11373-1329. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Primary Care, which is considered as her primary health care specialty. Kim, Sun Ja can be contacted via phone (718) 334-2490.

Contact Information

Primary practice address
7901 Broadway Managed Care, D1-01 Elmhurst NY 11373-1329
Phone: (718) 334-2490
Fax: (718) 334-3432
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Primary Care 363LP2300X F301430 New York

Profile Details

NPI number 1760563753
LBN Legal business name Kim, Sun Ja
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 18th, 2006
Last updated Apr 13th, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1760563753 NPPES
New York MEDICAID 00246075

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