Healthcare Provider Details

I. General information

NPI: 1831477280
Provider Name (Legal Business Name): PAUL Y KIM D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6083 MYRTLE AVE
RIDGEWOOD NY
11385-5908
US

IV. Provider business mailing address

18820B 69TH AVE APT 3B
FRESH MEADOWS NY
11365-3705
US

V. Phone/Fax

Practice location:
  • Phone: 718-381-8402
  • Fax: 718-497-7322
Mailing address:
  • Phone: 267-979-9670
  • Fax: 888-720-0690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN006427
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number006427
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: