Provider Demographics
NPI:1700045986
Name:KIM, TAEHO
Entity Type:Individual
Prefix:
First Name:TAEHO
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 S BEDFORD RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3408
Mailing Address - Country:US
Mailing Address - Phone:914-242-3651
Mailing Address - Fax:914-242-3753
Practice Address - Street 1:10 S BEDFORD RD
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3408
Practice Address - Country:US
Practice Address - Phone:914-242-3651
Practice Address - Fax:914-242-3753
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045520183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist