Provider Demographics
NPI:1386858694
Name:KIM, DUCK J (MD)
Entity Type:Individual
Prefix:DR
First Name:DUCK
Middle Name:J
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:210 CORNELIA STREET
Mailing Address - Street 2:SUITE #204
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2396
Mailing Address - Country:US
Mailing Address - Phone:518-563-8050
Mailing Address - Fax:518-563-8352
Practice Address - Street 1:210 CORNELIA STREET
Practice Address - Street 2:SUITE #204
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2396
Practice Address - Country:US
Practice Address - Phone:518-563-8050
Practice Address - Fax:518-563-8352
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2010-10-04
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Provider Licenses
StateLicense IDTaxonomies
NY110604207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000405443001OtherBLUESHIELD NORTHEASTERN
NY141603686OtherEXCELLUS
NY00511922Medicaid
NY00511922Medicaid
NY30726BMedicare PIN