Provider Demographics
NPI:1811985609
Name:KIM, BO YONG (RPH)
Entity type:Individual
Prefix:MR
First Name:BO YONG
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:972 AMSTERDAM AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-3497
Mailing Address - Country:US
Mailing Address - Phone:212-666-4800
Mailing Address - Fax:212-666-1145
Practice Address - Street 1:972 AMSTERDAM AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-3497
Practice Address - Country:US
Practice Address - Phone:212-666-4800
Practice Address - Fax:212-666-1145
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049059183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist