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General NPI Number Information
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NPI Number | 1649345349
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Entity Type | Individual
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Provider Name | WANG KI KIM MD
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Gender | Male
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 05/24/2011
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Provider Practice Location Address
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Address Line | 100 MEMORIAL DRIVE
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City | GOWANDA
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State | NY
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Zip | 14070
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Country | US
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Telephone | 716-532-9202
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Fax |
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Provider Business Mailing Address
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Address Line | 54425 LAKESHORE ROAD
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City | HAMBURG
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State | NY
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Zip | 14075
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Country | US
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Telephone | 716-627-3776
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Fax | 716-627-1162
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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 | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number | 1233901
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 1233901
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License Number State | NY
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