Provider Demographics
NPI:1659572220
Name:KIM, KYUNG H (MD)
Entity Type:Individual
Prefix:DR
First Name:KYUNG
Middle Name:H
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:262 E PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-1605
Mailing Address - Country:US
Mailing Address - Phone:914-668-2600
Mailing Address - Fax:914-668-6102
Practice Address - Street 1:262 E PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-1605
Practice Address - Country:US
Practice Address - Phone:914-668-2600
Practice Address - Fax:914-668-6102
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1508482086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00793453Medicaid
NYD38849Medicare UPIN
NY00793453Medicaid