Provider Demographics
NPI:1376945253
Name:KRI KHEM MEDICAL, PLLC
Entity Type:Organization
Organization Name:KRI KHEM MEDICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABSYLOM
Authorized Official - Middle Name:K
Authorized Official - Last Name:NYAMEKYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-836-3484
Mailing Address - Street 1:272 W 127TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-2910
Mailing Address - Country:US
Mailing Address - Phone:917-836-3484
Mailing Address - Fax:
Practice Address - Street 1:272 W 127TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-2910
Practice Address - Country:US
Practice Address - Phone:917-836-3484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-22
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208330207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty