Basic Information
| Provider Information | |||||||||
| NPI: | 1801128053 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | KYUNGAE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PMHNP-BC (PSYCHATRIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 WOODS AVE VALHALLA CAMPUS | ||||||||
| Address2: | WESTCHESTER MEDICAL CENTER | ||||||||
| City: | VALHALLA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9144937000 | ||||||||
| FaxNumber: | 9144932978 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 WOODS AVE | ||||||||
| Address2: | WESTCHESTER MEDICAL CENTER-BEHAVIOR HEALTH CENTER | ||||||||
| City: | VALHALLA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9144937000 | ||||||||
| FaxNumber: | 9144931015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2010 | ||||||||
| LastUpdateDate: | 05/08/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 459153 | NY | N | Nursing Service Providers | Registered Nurse | 363LP0808X | F401414-1/7534679 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 163W00000X | 459153-1 | NY | N | Nursing Service Providers | Registered Nurse |
No ID Information.