Provider Demographics
NPI:1346562170
Name:KIM, SIM MYUNG
Entity Type:Individual
Prefix:MRS
First Name:SIM
Middle Name:MYUNG
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 HUDSON PARK
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1569
Mailing Address - Country:US
Mailing Address - Phone:917-282-1600
Mailing Address - Fax:
Practice Address - Street 1:423 E 138TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-3041
Practice Address - Country:US
Practice Address - Phone:718-585-1071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-21
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35449183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist