Provider Demographics
NPI:1902815087
Name:KIM, STANLEY-SANGWOOK (DO)
Entity Type:Individual
Prefix:
First Name:STANLEY-SANGWOOK
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3372 170TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-1812
Mailing Address - Country:US
Mailing Address - Phone:646-642-7371
Mailing Address - Fax:718-428-1693
Practice Address - Street 1:38-34 PARSONS BLVD
Practice Address - Street 2:SUITE 1A
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354
Practice Address - Country:US
Practice Address - Phone:646-642-7371
Practice Address - Fax:718-428-1693
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-06
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238366208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology