Provider Demographics
NPI:1255407433
Name:KIM, MYUNG SOOK (MD)
Entity type:Individual
Prefix:
First Name:MYUNG
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 1:200 WEST 86TH STREET
Mailing Address - Street 2:SUITE 1 I
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3303
Mailing Address - Country:US
Mailing Address - Phone:212-873-0800
Mailing Address - Fax:212-724-6158
Practice Address - Street 1:200 WEST 86TH STREET
Practice Address - Street 2:SUITE 1 I
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3303
Practice Address - Country:US
Practice Address - Phone:212-873-0800
Practice Address - Fax:212-724-6158
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY163441207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01187315Medicaid
44F542Medicare ID - Type Unspecified
NY01187315Medicaid