Healthcare Provider Details

I. General information

NPI: 1467534131
Provider Name (Legal Business Name): DAVID AN-MOO RIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42-21 162ND STREET
FLUSHING NY
11358
US

IV. Provider business mailing address

4221 162ND ST
FLUSHING NY
11358-4150
US

V. Phone/Fax

Practice location:
  • Phone: 718-463-0101
  • Fax: 914-713-0036
Mailing address:
  • Phone: 718-463-0101
  • Fax: 914-713-0036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number129036
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: