Provider Demographics
NPI:1609826775
Name:KIM, MELODY (MD)
Entity Type:Individual
Prefix:
First Name:MELODY
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 1:220 NORTH CENTRAL PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530
Mailing Address - Country:US
Mailing Address - Phone:914-681-9750
Mailing Address - Fax:914-681-9755
Practice Address - Street 1:220 NORTH CENTRAL PARK AVE
Practice Address - Street 2:
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530
Practice Address - Country:US
Practice Address - Phone:914-681-9750
Practice Address - Fax:914-681-9755
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230237208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY230237-1OtherLICENSE NUMBER