Healthcare Provider Details

I. General information

NPI: 1295718351
Provider Name (Legal Business Name): CHARLES KIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 E 38TH ST 6TH FLOOR
NEW YORK NY
10016
US

IV. Provider business mailing address

333 E 38TH ST 6TH FLOOR
NEW YORK NY
10016-2772
US

V. Phone/Fax

Practice location:
  • Phone: 646-501-7200
  • Fax: 646-501-7432
Mailing address:
  • Phone: 646-501-7200
  • Fax: 646-501-7432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number220814
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number220814
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number220814
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: