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General NPI Number Information
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NPI Number | 1487868360
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Entity Type | Organization
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Legal Business Name | YONG JUN KIM MD PC
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 04/12/2013
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Provider Practice Location Address
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Address Line | 164-10 NORTHERN BLVD SUITE # 206
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City | FLUSHING
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State | NY
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Zip | 11358
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Country | US
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Telephone | 718-321-2940
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Fax |
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Provider Business Mailing Address
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Address Line | 54 MOTT AVE
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City | ROSLYN
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State | NY
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Zip | 11576-1612
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Country | US
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Telephone | 718-321-2940
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. YONG JUN KIM
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Credential | M.D.
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Telephone | 718-321-2940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 236715
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License Number State | NY
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