Healthcare Provider Details

I. General information

NPI: 1639224843
Provider Name (Legal Business Name): HANNAH KYUNG ME KIM DPM, MSC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 E 79TH ST OFC 1A
NEW YORK NY
10075-1409
US

IV. Provider business mailing address

460 E 79TH ST OFC 1A
NEW YORK NY
10075-1409
US

V. Phone/Fax

Practice location:
  • Phone: 212-860-3339
  • Fax: 212-988-7806
Mailing address:
  • Phone: 212-860-3339
  • Fax: 212-988-7806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN005804
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: