Healthcare Provider Details

I. General information

NPI: 1508070350
Provider Name (Legal Business Name): MYUNG HYO KIM, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 TROY SCHENECTADY RD
LATHAM NY
12110-2442
US

IV. Provider business mailing address

711 TROY SCHENECTADY RD
LATHAM NY
12110-2442
US

V. Phone/Fax

Practice location:
  • Phone: 518-783-0710
  • Fax:
Mailing address:
  • Phone: 518-783-0710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: MYUNG HYO KIM
Title or Position: OWNER
Credential: MD
Phone: 518-783-0710