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General NPI Number Information
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NPI Number | 1659559888
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Entity Type | Organization
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Legal Business Name | KKB MEDICAL, P.C.
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Dates
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Enumeration Date | 02/11/2008
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Last Update Date | 02/11/2008
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Provider Practice Location Address
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Address Line | 1317 3RD AVE
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City | NEW YORK
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State | NY
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Zip | 10021-2995
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Country | US
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Telephone | 212-794-0240
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Fax |
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Provider Business Mailing Address
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Address Line | 1317 3RD AVE
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City | NEW YORK
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State | NY
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Zip | 10021-2995
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Country | US
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Telephone | 212-794-0240
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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. PETER SUNG WON KIM
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Credential | M.D.
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Telephone | 212-794-0240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 225713
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License Number State | NY
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