Healthcare Provider Details

I. General information

NPI: 1699207092
Provider Name (Legal Business Name): LESLIE KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 10TH AVE
NEW YORK NY
10019-1147
US

IV. Provider business mailing address

1000 10TH AVE
NEW YORK NY
10019-1147
US

V. Phone/Fax

Practice location:
  • Phone: 212-523-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number310670
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: