MEDICARE: JEONG SOOK KIM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	067009	NY

General Provider Information

NPI Number	:	1144806001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEONG SOOK KIM

Provider Business Mailing Address
First Line	:	7 GALWAY RD
Second Line	:
City	:	NEW HARTFORD
State	:	NY
Zip	:	13413-2240
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7 GALWAY RD
Second Line	:
City	:	NEW HARTFORD
State	:	NY
Zip	:	13413-2240
Country	:	US
Telephone Number	:	315-507-2027
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2021
Last Update Date	:	03/22/2021

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Directions to “ JEONG SOOK KIM ” Practice Location

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