Provider Demographics
NPI:1952387904
Name:KIM, DAMIAN BYUNGSUK (MD)
Entity Type:Individual
Prefix:DR
First Name:DAMIAN
Middle Name:BYUNGSUK
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BYUNG-SUK
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:24 N 3RD AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2448
Mailing Address - Country:US
Mailing Address - Phone:917-696-7107
Mailing Address - Fax:
Practice Address - Street 1:24 N 3RD AVE STE 202
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2448
Practice Address - Country:US
Practice Address - Phone:917-696-7107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1102942084P0800X
NJ25MA030721002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00196992Medicaid
NY00196992Medicaid
NY582213Medicare ID - Type Unspecified