Provider Demographics
NPI:1740251701
Name:KIM, SEUNG KWAN (MD)
Entity type:Individual
Prefix:DR
First Name:SEUNG
Middle Name:KWAN
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:3520 147TH ST
Mailing Address - Street 2:SUITE 1D,1E,1F
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-3765
Mailing Address - Country:US
Mailing Address - Phone:718-321-2870
Mailing Address - Fax:718-321-2891
Practice Address - Street 1:3520 147TH ST
Practice Address - Street 2:SUITE 1D,1E,1F
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-3765
Practice Address - Country:US
Practice Address - Phone:718-321-2870
Practice Address - Fax:718-321-2891
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY169723208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01093241Medicaid
NY01093241Medicaid