Healthcare Provider Details

I. General information

NPI: 1982600185
Provider Name (Legal Business Name): YOONSUNG KIM O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 02/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 5TH AVE FLOOR 2
NEW YORK NY
10001-3605
US

IV. Provider business mailing address

310 5TH AVE FLOOR 2
NEW YORK NY
10001-3605
US

V. Phone/Fax

Practice location:
  • Phone: 212-971-0911
  • Fax: 212-714-2097
Mailing address:
  • Phone: 212-971-0911
  • Fax: 212-714-2097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV004298
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: