Provider Demographics
NPI:1275693467
Name:KIM, KYUNG OK (MD)
Entity Type:Individual
Prefix:
First Name:KYUNG
Middle Name:OK
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WOODBURY COURT
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-3159
Mailing Address - Country:US
Mailing Address - Phone:516-931-0424
Mailing Address - Fax:516-938-5580
Practice Address - Street 1:2 WOODBURY COURT
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-3159
Practice Address - Country:US
Practice Address - Phone:516-931-0424
Practice Address - Fax:516-938-5580
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY125913207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
55872Medicare UPIN