Provider Demographics
NPI:1205926003
Name:KIM, PAUL H (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:H
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 VASSAR PL
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-4911
Mailing Address - Country:US
Mailing Address - Phone:866-633-8255
Mailing Address - Fax:718-405-8278
Practice Address - Street 1:170 MAPLE AVE STE 309
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4714
Practice Address - Country:US
Practice Address - Phone:914-220-0283
Practice Address - Fax:914-220-0288
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204946207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01955086Medicaid