Healthcare Provider Details

I. General information

NPI: 1487585576
Provider Name (Legal Business Name): ASHLEY HERYN KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 BEN BAR CIR
WHITESBORO NY
13492-3023
US

IV. Provider business mailing address

SQUIRE HALL 320 HAYES RD
BUFFALO NY
14214
US

V. Phone/Fax

Practice location:
  • Phone: 315-534-8830
  • Fax:
Mailing address:
  • Phone: 716-645-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: