Provider Demographics
NPI:1659136216
Name:KIM, MEEKYOUNG
Entity Type:Individual
Prefix:
First Name:MEEKYOUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4832 CLEARVIEW EXPY
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GDNS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-1040
Mailing Address - Country:US
Mailing Address - Phone:917-378-2728
Mailing Address - Fax:
Practice Address - Street 1:4832 CLEARVIEW EXPY
Practice Address - Street 2:
Practice Address - City:OAKLAND GDNS
Practice Address - State:NY
Practice Address - Zip Code:11364-1040
Practice Address - Country:US
Practice Address - Phone:917-378-2728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-13
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006736-01156FX1800X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician