MEDICARE: STEVE YUN KIM MD

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	207Y00000X	Otolaryngology Physician	MA069506	NJ
2	207Y00000X	Otolaryngology Physician	214572	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225105414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVE YUN KIM MD

Provider Business Mailing Address
First Line	:	2185 LEMOINE AVE
Second Line	:	UNIT 1P
City	:	FORT LEE
State	:	NJ
Zip	:	07024-6036
Country	:	US
Telephone Number	:	201-569-9130
Fax Number	:	201-569-9131

Provider Business Practice Location Address
First Line	:	2185 LEMOINE AVE
Second Line	:	UNIT 1P
City	:	FORT LEE
State	:	NJ
Zip	:	07024-6036
Country	:	US
Telephone Number	:	201-569-9130
Fax Number	:	201-569-9131

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

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	12/14/2015

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