Provider Demographics
NPI:1679821011
Name:TAEGYUN KIM MD PC
Entity Type:Organization
Organization Name:TAEGYUN KIM MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TAEGYUN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-318-0507
Mailing Address - Street 1:14147 NORTHERN BLVD
Mailing Address - Street 2:SUITE #2R
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4238
Mailing Address - Country:US
Mailing Address - Phone:718-461-2701
Mailing Address - Fax:
Practice Address - Street 1:14147 NORTHERN BLVD
Practice Address - Street 2:SUITE #2R
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4238
Practice Address - Country:US
Practice Address - Phone:718-461-2701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY263541261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center