Healthcare Provider Details

I. General information

NPI: 1336579747
Provider Name (Legal Business Name): SEO HEE KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2013
Last Update Date: 01/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 E 23RD ST RESPIRATORY CARE SERVICES ROOM 13090S
NEW YORK NY
10010-5011
US

IV. Provider business mailing address

423 E 23RD ST
NEW YORK NY
10010-5011
US

V. Phone/Fax

Practice location:
  • Phone: 212-686-7500
  • Fax: 212-951-6882
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number008670
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: