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NPI Code Detail

MEDICARE: DR. MARK Y KIM D.O.

MEDICARE: DR. MARK Y KIM D.O.
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
1207R00000XInternal Medicine Physician234385-1NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10412847OTHERNYIHA
200027258001OTHERNYUNIVERA
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4000528214001OTHERNYHEALTH NOW
5161000580OTHERNMEMPIRE PLAN

General Provider Information

NPI Number : 1487633228
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK Y KIM D.O.
Provider Business Mailing Address
First Line : 425 ESSJAY RD STE 170
Second Line :
City : WILLIAMSVILLE
State : NY
Zip : 14221-8235
Country : US
Telephone Number : 716-630-1219
Fax Number : 716-817-1726
Provider Business Practice Location Address
First Line : 3900 N BUFFALO ST
Second Line :
City : ORCHARD PARK
State : NY
Zip : 14127-1842
Country : US
Telephone Number : 716-656-4804
Fax Number : 716-250-5933
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2006
Last Update Date : 11/16/2020

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