=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023095171
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BETTE KIM M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2005
-----------------------------------------------------
Last Update Date | 05/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 425 W 59TH ST 9-C
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10019-1104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-492-5550
-----------------------------------------------------
Fax | 212-492-5555
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 700 HICKSVILLE RD
-----------------------------------------------------
City | BETHPAGE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11714-3471
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 218819
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------