Healthcare Provider Details

I. General information

NPI: 1679560593
Provider Name (Legal Business Name): KIM YASMINE WILLIAMS MB, BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 09/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5645 MAIN ST DEPARTMENT OF PEDIATRICS
FLUSHING NY
11355-5045
US

IV. Provider business mailing address

10 WATERSIDE PLZ APT 30B
NEW YORK NY
10010-2602
US

V. Phone/Fax

Practice location:
  • Phone: 718-670-1033
  • Fax:
Mailing address:
  • Phone: 917-860-9343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number211227
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: