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General NPI Number Information
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NPI Number | 1831487115
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Entity Type | Organization
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Legal Business Name | MPG MEDICAL SERVICES, PLLC
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Dates
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Enumeration Date | 07/20/2011
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Last Update Date | 08/10/2011
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Provider Practice Location Address
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Address Line | 535 5TH AVE 5TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10017-3620
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Country | US
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Telephone | 212-874-3384
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Fax | 212-874-0031
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Provider Business Mailing Address
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Address Line | 535 5TH AVE 5TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10017-3620
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Country | US
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Telephone | 212-874-3384
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Fax | 212-874-0031
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Authorized Official
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Title or Position | OWNER
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Name | DR. PETER KIM
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Credential | MD
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Telephone | 212-874-3384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 190910
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License Number State | NY
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