MEDICARE: DR. HAE-OK KIM M.D

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	174400000X	Specialist	2205131	NY
2	207Y00000X	Otolaryngology Physician	220513	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

General Provider Information

NPI Number	:	1407808876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HAE-OK KIM M.D

Provider Business Mailing Address
First Line	:	180 FORT WASHINGTON AVE FL 8
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-3722
Country	:	US
Telephone Number	:	212-305-8555
Fax Number	:	212-305-3975

Provider Business Practice Location Address
First Line	:	180 FORT WASHINGTON AVE FL 7
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-3722
Country	:	US
Telephone Number	:	212-305-8555
Fax Number	:	212-305-3975

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

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	03/17/2018

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