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General NPI Number Information
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NPI Number | 1770584021
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Entity Type | Individual
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Provider Name | SUK SIK KIM M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 333 N MAIN ST
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City | FREEPORT
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State | NY
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Zip | 11520-1231
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Country | US
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Telephone | 516-623-3322
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Fax | 516-623-3526
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Provider Business Mailing Address
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Address Line | 70 EDGEWOOD DR
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-3738
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Country | US
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Telephone | 516-248-6506
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 110412
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License Number State | NY
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