Provider Demographics
NPI:1932283074
Name:KIM, DONG SUNG (MD)
Entity Type:Individual
Prefix:
First Name:DONG
Middle Name:SUNG
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1 BROOKDALE PLAZA
Mailing Address - Street 2:BROOKDALE HOSPITAL, DEPT. OF PATHOLOGY
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-3198
Mailing Address - Country:US
Mailing Address - Phone:718-240-5415
Mailing Address - Fax:718-240-5424
Practice Address - Street 1:1 BROOKDALE PLZ
Practice Address - Street 2:BROOKDALE HOSPITAL, DEPT. OF PATHOLOGY
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-3139
Practice Address - Country:US
Practice Address - Phone:718-240-5415
Practice Address - Fax:718-240-5424
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY119173207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
34284100Medicare ID - Type Unspecified
D46772Medicare UPIN