Individual ProviderYoungyun KimNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address2015 Grand Concourse, Bronx, NY 10453-4303(718) 299-7295(718) 618-0401PECOS EnrollmentBased on the most recent information from CMS, provider Youngyun Kim is legally eligible to order and refer claims for DME and PMD services only.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1124424221Provider TypeIndividualFull NameKim, YoungyunGenderFemaleSole ProprietorNoEnumeration Date11/17/2014Last Updated11/17/2014Contact InformationPractice LocationPractice Address2015 Grand Concourse, Bronx, NY 10453-4303Phone(718) 299-7295Fax(718) 299-6797Mailing LocationMailing Address3198 Grand Concourse, Bronx, NY 10458-1000Phone(718) 618-0401Fax(718) 795-4394Provider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense338299New YorkCode163W00000XDescriptionRegistered NurseNursing Service ProvidersLicense565420New York