Healthcare Provider Details

I. General information

NPI: 1457445512
Provider Name (Legal Business Name): YOUNG HEE KIM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 05/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 WEST UTICA ST
OSWEGO NY
13126
US

IV. Provider business mailing address

50 WEST UTICA ST
OSWEGO NY
13126
US

V. Phone/Fax

Practice location:
  • Phone: 315-342-2313
  • Fax: 315-342-3087
Mailing address:
  • Phone: 315-342-2313
  • Fax: 315-342-3087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number149450
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: