Provider Demographics
NPI:1982641742
Name:KIM, YOUNG SOOK (MD)
Entity Type:Individual
Prefix:
First Name:YOUNG
Middle Name:SOOK
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 CLAUDIA CT
Mailing Address - Street 2:
Mailing Address - City:TAPPAN
Mailing Address - State:NY
Mailing Address - Zip Code:10983-1936
Mailing Address - Country:US
Mailing Address - Phone:845-359-0289
Mailing Address - Fax:845-359-3241
Practice Address - Street 1:33 CLAUDIA CT
Practice Address - Street 2:
Practice Address - City:TAPPAN
Practice Address - State:NY
Practice Address - Zip Code:10983-1936
Practice Address - Country:US
Practice Address - Phone:845-359-0289
Practice Address - Fax:845-359-3241
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2016-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA045690002085R0001X
NY15308012085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01440784Medicaid
NJ8791503Medicaid
NJ894028Medicare ID - Type Unspecified
E74326Medicare UPIN
NY01440784Medicaid