MEDICARE: AEYOUNG 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	207R00000X	Internal Medicine Physician	108203	NY

General Provider Information

NPI Number	:	1497753990
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AEYOUNG KIM, M.D.

Provider Business Mailing Address
First Line	:	40 PARK DR
Second Line	:
City	:	WOODSTOCK
State	:	NY
Zip	:	12498-1727
Country	:	US
Telephone Number	:	845-679-8728
Fax Number	:	845-679-1034

Provider Business Practice Location Address
First Line	:	40 PARK DR
Second Line	:
City	:	WOODSTOCK
State	:	NY
Zip	:	12498-1727
Country	:	US
Telephone Number	:	845-679-8728
Fax Number	:	845-679-1034

Authorized Official
Title or Position	:	M.D.
Name	:	DR. AEYOUNG LEE KIM
Credential	:	M.D.
Telephone Number	:	845-679-8728

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	11/27/2007

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