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General NPI Number Information
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NPI Number | 1710220561
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Entity Type | Organization
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Legal Business Name | KS PODIATRY PC
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Dates
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Enumeration Date | 03/30/2013
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Last Update Date | 10/22/2025
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Provider Practice Location Address
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Address Line | 21909 NORTHERN BLVD
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City | BAYSIDE
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State | NY
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Zip | 11361-3525
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Country | US
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Telephone | 718-229-9200
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Fax | 866-668-7533
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Provider Business Mailing Address
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Address Line | 995 OLD COUNTRY RD
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City | PLAINVIEW
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State | NY
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Zip | 11803-4906
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Country | US
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Telephone | 718-229-9200
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Fax | 866-668-7533
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Authorized Official
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Title or Position | PRESIDENT
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Name | KWANGSU KIM
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Credential | DPM
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Telephone | 718-229-9200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | N006264
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License Number State | NY
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