Provider Demographics
NPI:1992473706
Name:KIM, HYEONGYU (NP)
Entity type:Individual
Prefix:
First Name:HYEONGYU
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:413 29TH ST NE STE I
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-7154
Mailing Address - Country:US
Mailing Address - Phone:855-255-1750
Mailing Address - Fax:855-255-0905
Practice Address - Street 1:5200 MEADOWS RD STE 200
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-0086
Practice Address - Country:US
Practice Address - Phone:855-255-1750
Practice Address - Fax:855-255-0905
Is Sole Proprietor?:No
Enumeration Date:2021-09-06
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR201602206RN163WG0000X
WAAP61354264363L00000X
OR202211907NP-PP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice