MEDICARE: YOUNG WHAN KIM

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	151047	NY

General Provider Information

NPI Number	:	1639343411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOUNG WHAN KIM

Provider Business Mailing Address
First Line	:	3130 GRAND CONCOURSE STE 1N
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-1263
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3130 GRAND CONCOURSE STE 1N
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-1263
Country	:	US
Telephone Number	:	718-365-0892
Fax Number	:

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

Provider Enumeration Date	:	04/14/2008
Last Update Date	:	09/30/2008

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Directions to “ YOUNG WHAN KIM ” Practice Location

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