Provider Demographics
NPI:1548234156
Name:KIM, ALBERT N (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:N
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1500 ROUTE 112 BLDG 4
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-8055
Mailing Address - Country:US
Mailing Address - Phone:631-751-3000
Mailing Address - Fax:631-509-6559
Practice Address - Street 1:2500 NESCONSET HWY BLDG 21A
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-2598
Practice Address - Country:US
Practice Address - Phone:631-751-3000
Practice Address - Fax:631-509-6559
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2020-01-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1676611208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY15L682Medicare PIN
NYF79048Medicare UPIN
NY5494770001Medicare NSC