Individual ProviderSongyeon KimNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address727 N Waco Ave Ste 570, Wichita, KS 67203-3986(316) 295-3015PECOS EnrollmentBased on the most recent information from CMS, provider Songyeon Kim does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1508614918Provider TypeIndividualFull NameKim, SongyeonCredentialAPRNGenderFemaleSole ProprietorNoEnumeration Date5/9/2024Last Updated5/14/2024Contact InformationPractice LocationPractice Address727 N Waco Ave Ste 570, Wichita, KS 67203-3986Phone(316) 295-3015FaxUnlisted FaxMailing LocationMailing Address727 N Waco Ave Ste 570, Wichita, KS 67203-3986Phone(316) 295-3015FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense53-83196-112Kansas