Provider Demographics
NPI:1922727015
Name:KIM, RAYMOND JUNMOK
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:JUNMOK
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 1:15 RENEE RD
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-2832
Mailing Address - Country:US
Mailing Address - Phone:917-617-6984
Mailing Address - Fax:855-825-9444
Practice Address - Street 1:15 RENEE RD
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-2832
Practice Address - Country:US
Practice Address - Phone:917-617-6984
Practice Address - Fax:855-825-9444
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies