Basic Information
| Provider Information | |||||||||
| NPI: | 1245996784 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | KIM | ||||||||
| FirstName: | NATHAN | ||||||||
| MiddleName: | DAEBHUM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6051 PALM TRACE LANDINGS DR APT 306 | ||||||||
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| City: | DAVIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333141870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6787023050 | ||||||||
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| Practice Location | |||||||||
| Address1: | WOODHULL MEDICAL CENTER 760 BROADWAY | ||||||||
| Address2: | ROOM 2C319 | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189638310 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2021 | ||||||||
| LastUpdateDate: | 11/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.