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General NPI Number Information
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NPI Number | 1134210339
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Entity Type | Organization
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Legal Business Name | YOUNG W. KIM
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3130 GRANDCONCOURSE 1N
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City | BRONX
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State | NY
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Zip | 10458
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Country | US
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Telephone | 718-561-8499
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Fax |
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Provider Business Mailing Address
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Address Line | 3130 GRANDCONCOURSE 1N
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City | BRONX
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State | NY
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Zip | 10458
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Country | US
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Telephone | 718-561-8499
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Fax |
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Authorized Official
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Title or Position | MD
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Name | YOUNG KIM
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Credential |
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Telephone | 718-365-0892
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 151047
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License Number State | NY
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