Provider Demographics
NPI:1396103669
Name:KO, JOUNGMIN (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:JOUNGMIN
Middle Name:
Last Name:KO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 W 51ST ST STE 380
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-6113
Mailing Address - Country:US
Mailing Address - Phone:212-326-8941
Mailing Address - Fax:212-326-8946
Practice Address - Street 1:51 W 51ST ST STE 380
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-6113
Practice Address - Country:US
Practice Address - Phone:212-326-8941
Practice Address - Fax:212-326-8946
Is Sole Proprietor?:No
Enumeration Date:2016-02-02
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY341722363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily