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General NPI Number Information
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NPI Number | 1164012746
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Entity Type | Organization
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Legal Business Name | DR. P.KIM PODIATRY, P.C.
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Dates
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Enumeration Date | 01/19/2021
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Last Update Date | 01/19/2021
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Provider Practice Location Address
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Address Line | 14218 38TH AVE STE 1B
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City | FLUSHING
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State | NY
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Zip | 11354-5654
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Country | US
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Telephone | 646-762-4331
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Fax | 888-720-0690
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Provider Business Mailing Address
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Address Line | 18820B 69TH AVE APT 3B
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City | FRESH MEADOWS
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State | NY
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Zip | 11365-3705
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Country | US
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Telephone | 646-762-4331
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Fax | 888-720-0690
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Authorized Official
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Title or Position | PRESIDENT
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Name | PAUL Y KIM
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Credential | DPM
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Telephone | 267-979-9670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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