Provider Demographics
NPI:1235203852
Name:KIM'S ORTHOPEDIC SHOES,INC
Entity Type:Organization
Organization Name:KIM'S ORTHOPEDIC SHOES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KI
Authorized Official - Middle Name:H
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-661-2001
Mailing Address - Street 1:15603 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5033
Mailing Address - Country:US
Mailing Address - Phone:718-661-2001
Mailing Address - Fax:718-661-1072
Practice Address - Street 1:15603 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5033
Practice Address - Country:US
Practice Address - Phone:718-661-2001
Practice Address - Fax:718-661-1072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01588563Medicaid
NY0477290001Medicare NSC