Provider Demographics
NPI:1467534131
Name:RIM, DAVID AN-MOO (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:AN-MOO
Last Name:RIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4221 162ND ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-4150
Mailing Address - Country:US
Mailing Address - Phone:718-463-0101
Mailing Address - Fax:914-713-0036
Practice Address - Street 1:42-21 162ND STREET
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358
Practice Address - Country:US
Practice Address - Phone:718-463-0101
Practice Address - Fax:914-713-0036
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129036207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00585846Medicaid
NY00585846Medicaid
NY47A331Medicare PIN