Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Ju Yeon Kim

Individual provider Family Nurse Practitioner · NPI 1710764550

Ju Yeon Kim is a Nurse Practitioner in Fayetteville, New York. Qualified in 2023, 3 years ago. Practices with St Josephs Medical PC, a 385-clinician group, accepts Medicare assignment and offers telehealth. Licensed in New York.

Years since qualifying
3
Licensed in
NY
In the registry since
2023
Claim this listing Report a problem Suggest an edit

Practice location Address checks out

4000 Medical Ctr Ste 212
Fayetteville, NY 13066
Phone: (315) 744-1570
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 351939 (NY)

Record details

NPI number1710764550
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedSeptember 14, 2023
Last updated in NPPESMay 16, 2024
Certification dateMay 9, 2024
Mailing address4000 Medical Center Dr, Suite 212, Fayetteville, NY 13066

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice St Josephs Medical Pc — 385 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations4 on file with Medicare

Other providers in Fayetteville