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General NPI Number Information
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NPI Number | 1679821011
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Entity Type | Organization
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Legal Business Name | TAEGYUN KIM MD PC
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Dates
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Enumeration Date | 08/15/2012
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Last Update Date | 08/15/2012
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Provider Practice Location Address
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Address Line | 14147 NORTHERN BLVD SUITE #2R
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City | FLUSHING
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State | NY
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Zip | 11354-4238
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Country | US
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Telephone | 718-461-2701
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Fax |
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Provider Business Mailing Address
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Address Line | 14147 NORTHERN BLVD SUITE #2R
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City | FLUSHING
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State | NY
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Zip | 11354-4238
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Country | US
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Telephone | 718-461-2701
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. TAEGYUN KIM
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Credential | M.D.
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Telephone | 301-318-0507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 263541
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License Number State | NY
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