Provider Demographics
NPI:1699035626
Name:KIM, DENNIS (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 WASHINGTON AVENUE EXT STE 201
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-6352
Mailing Address - Country:US
Mailing Address - Phone:518-452-1928
Mailing Address - Fax:518-362-1348
Practice Address - Street 1:264 WASHINGTON AVENUE EXT STE 201
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-6352
Practice Address - Country:US
Practice Address - Phone:518-452-1928
Practice Address - Fax:518-362-1348
Is Sole Proprietor?:No
Enumeration Date:2012-05-23
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA129827207N00000X
MA270858207N00000X
NY297062-01207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology