Provider Demographics
NPI:1790715274
Name:GARCIA, CHRISTINE KIM (MD PHD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:KIM
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:MARIE
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:630 W 168TH ST # 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3725
Mailing Address - Country:US
Mailing Address - Phone:212-305-8203
Mailing Address - Fax:212-305-8424
Practice Address - Street 1:622 W 168TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3720
Practice Address - Country:US
Practice Address - Phone:212-305-8203
Practice Address - Fax:212-305-8424
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297050207RC0200X, 207RP1001X
TXL2267207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173522701Medicaid
TX8D5441Medicare ID - Type Unspecified