Provider Demographics
NPI:1982600185
Name:KIM, YOONSUNG (OD)
Entity Type:Individual
Prefix:DR
First Name:YOONSUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 5TH AVE
Mailing Address - Street 2:FLOOR 2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-3605
Mailing Address - Country:US
Mailing Address - Phone:212-971-0911
Mailing Address - Fax:212-714-2097
Practice Address - Street 1:310 5TH AVE
Practice Address - Street 2:FLOOR 2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3605
Practice Address - Country:US
Practice Address - Phone:212-971-0911
Practice Address - Fax:212-714-2097
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV004298152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00791906Medicaid
NY0964880001Medicare NSC
NYC2A301Medicare PIN
NY00791906Medicaid