Provider Demographics
NPI:1922550920
Name:KIM, DOOYOUNG
Entity Type:Individual
Prefix:
First Name:DOOYOUNG
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 1:20312 35TH AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-1110
Mailing Address - Country:US
Mailing Address - Phone:646-725-4995
Mailing Address - Fax:646-558-7797
Practice Address - Street 1:61-43 186TH STREET
Practice Address - Street 2:SUITE #408
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365
Practice Address - Country:US
Practice Address - Phone:646-725-4995
Practice Address - Fax:646-558-7797
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-26
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYB02955344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi