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General NPI Number Information
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NPI Number | 1548967482
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Entity Type | Individual
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Provider Name | MYUNG SOOK KIM MDPP
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Gender | Female
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Dates
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Enumeration Date | 02/10/2023
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Last Update Date | 02/10/2023
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Provider Practice Location Address
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Address Line | 20305 32ND AVE
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City | BAYSIDE
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State | NY
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Zip | 11361-1021
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Country | US
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Telephone | 718-939-6137
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Fax |
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Provider Business Mailing Address
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Address Line | 21509 47TH AVE APT 3C
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City | BAYSIDE
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State | NY
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Zip | 11361-3414
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Country | US
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Telephone | 646-465-2886
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State | NY
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