Provider Demographics
NPI:1497753990
Name:AEYOUNG KIM, M.D.
Entity Type:Organization
Organization Name:AEYOUNG KIM, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:AEYOUNG
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-679-8728
Mailing Address - Street 1:40 PARK DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:NY
Mailing Address - Zip Code:12498-1727
Mailing Address - Country:US
Mailing Address - Phone:845-679-8728
Mailing Address - Fax:845-679-1034
Practice Address - Street 1:40 PARK DR
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:NY
Practice Address - Zip Code:12498-1727
Practice Address - Country:US
Practice Address - Phone:845-679-8728
Practice Address - Fax:845-679-1034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY108203207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC11753Medicare UPIN