| NPI | 1619862943 |
|---|---|
| Other Name | REVIVE WELLNESS |
| Entity Type | Organization |
| Authorized Contact | HYUNCHU KIM GOLD Staff Nurse Practitioner 917-309-0729 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2025-06-09 |
| Last Update Date | 2025-06-25 |