Provider Demographics
NPI:1790857126
Name:KIM, YOOJIN (MD)
Entity Type:Individual
Prefix:DR
First Name:YOOJIN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158-14 NORTHERN BOULEVARD
Mailing Address - Street 2:SUITE ML7
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358
Mailing Address - Country:US
Mailing Address - Phone:718-463-8100
Mailing Address - Fax:718-463-8409
Practice Address - Street 1:15814 NORTHERN BLVD
Practice Address - Street 2:SUITE ML7
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-1600
Practice Address - Country:US
Practice Address - Phone:718-463-8100
Practice Address - Fax:718-463-8409
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200773208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics