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General NPI Number Information
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NPI Number | 1194738500
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Entity Type | Organization
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Legal Business Name | DUCK J KIM MD PC
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 03/09/2011
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Provider Practice Location Address
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Address Line | 210 CORNELIA ST STE 204
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City | PLATTSBURGH
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State | NY
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Zip | 12901-2396
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Country | US
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Telephone | 518-563-8050
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Fax | 518-563-8352
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Provider Business Mailing Address
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Address Line | 210 CORNELIA ST STE 204
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City | PLATTSBURGH
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State | NY
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Zip | 12901-2396
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Country | US
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Telephone | 518-563-8050
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Fax | 518-563-8352
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Authorized Official
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Title or Position | OWNER
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Name | DUCK J KIM
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Credential | MD
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Telephone | 518-563-8050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 110604
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License Number State | NY
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