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NPI Code Detail

MEDICARE: KIM FAMOUS PA

MEDICARE: KIM FAMOUS PA
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
1363A00000XPhysician Assistant008614-1NY

General Provider Information

NPI Number : 1457781890
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIM FAMOUS PA
Provider Business Mailing Address
First Line : 645 MINNIEFORD AVE
Second Line :
City : BRONX
State : NY
Zip : 10464-1121
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 645 MINNIEFORD AVE
Second Line :
City : BRONX
State : NY
Zip : 10464-1121
Country : US
Telephone Number : 917-703-5700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2013
Last Update Date : 11/21/2013

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Directions to “ KIM FAMOUS PA” Practice Location

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