Provider Demographics
NPI:1518954957
Name:KIM, KYUNGMEE (MD)
Entity Type:Individual
Prefix:
First Name:KYUNGMEE
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13710 FRANKLIN AVE
Mailing Address - Street 2:#L-1
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3842
Mailing Address - Country:US
Mailing Address - Phone:718-359-0005
Mailing Address - Fax:718-762-9296
Practice Address - Street 1:13710 FRANKLIN AVE
Practice Address - Street 2:#L-1
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3842
Practice Address - Country:US
Practice Address - Phone:718-359-0005
Practice Address - Fax:718-762-9296
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175595207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01849090Medicaid
NYE62653Medicare UPIN
NY01849090Medicaid