Provider Demographics
NPI:1659714582
Name:KIM, ALEXANDER NAMHYUN (DO)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:NAMHYUN
Last Name:KIM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:391 1ST ST
Mailing Address - Street 2:4R
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-2548
Mailing Address - Country:US
Mailing Address - Phone:847-302-3646
Mailing Address - Fax:
Practice Address - Street 1:1551 RICHMOND RD
Practice Address - Street 2:1A
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-2313
Practice Address - Country:US
Practice Address - Phone:718-987-4891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDO3163207Q00000X
NJ25MB10470400207Q00000X
TXS3833207Q00000X
NY278707207Q00000X
CODR.0065537207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine