Provider Demographics
NPI:1922195239
Name:KIM, KEE YOUNG (MD)
Entity Type:Individual
Prefix:MR
First Name:KEE
Middle Name:YOUNG
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:41 10 BOWNE STREET
Mailing Address - Street 2:SUITE L2
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5606
Mailing Address - Country:US
Mailing Address - Phone:718-353-4855
Mailing Address - Fax:718-353-7939
Practice Address - Street 1:41 10 BOWNE STREET
Practice Address - Street 2:SUITE L2
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5606
Practice Address - Country:US
Practice Address - Phone:718-353-4855
Practice Address - Fax:718-353-7939
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY165138207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00930305Medicaid
NY07433Medicare ID - Type Unspecified
A63480Medicare UPIN