Healthcare Provider Details

I. General information

NPI: 1497913149
Provider Name (Legal Business Name): SUNG YUP KIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13516 ROOSEVELT AVE STE 2
FLUSHING NY
11354-5366
US

IV. Provider business mailing address

1425 MADISON AVE BOX 1273
NEW YORK NY
10029
US

V. Phone/Fax

Practice location:
  • Phone: 212-257-2492
  • Fax: 212-987-9310
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number261334
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number261334
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: