Provider Demographics
NPI:1336237817
Name:KIM, DOSIK (MD)
Entity Type:Individual
Prefix:DR
First Name:DOSIK
Middle Name:
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 1:5947 AMBOY RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-3118
Mailing Address - Country:US
Mailing Address - Phone:718-605-2970
Mailing Address - Fax:718-605-7180
Practice Address - Street 1:5947 AMBOY RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-3118
Practice Address - Country:US
Practice Address - Phone:718-605-2970
Practice Address - Fax:718-605-7180
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309099207RC0200X, 207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015608900001Medicaid
PA100146Medicare PIN
PAIS1396Medicare UPIN