Provider Demographics
NPI:1609018241
Name:KIM, WON KYU
Entity Type:Individual
Prefix:MR
First Name:WON
Middle Name:KYU
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13687 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4110
Mailing Address - Country:US
Mailing Address - Phone:718-359-3355
Mailing Address - Fax:718-445-8540
Practice Address - Street 1:13687 37TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4110
Practice Address - Country:US
Practice Address - Phone:718-359-3355
Practice Address - Fax:718-445-8540
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic