Provider Demographics
NPI:1679560593
Name:WILLIAMS, KIM YASMINE (MB, BS)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:YASMINE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MB, BS
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Mailing Address - Street 1:10 WATERSIDE PLZ
Mailing Address - Street 2:APT 30B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-2602
Mailing Address - Country:US
Mailing Address - Phone:917-860-9343
Mailing Address - Fax:
Practice Address - Street 1:5645 MAIN ST
Practice Address - Street 2:DEPARTMENT OF PEDIATRICS
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5045
Practice Address - Country:US
Practice Address - Phone:718-670-1033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2112272080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02174234Medicaid