MEDICARE: DR. GENE KIM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	5315056243	MI
2	207WX0009X	Glaucoma Specialist (Ophthalmology) Physician	283443	NY

General Provider Information

NPI Number	:	1033474820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GENE KIM M.D.

Provider Business Mailing Address
First Line	:	340 E 23RD ST
Second Line	:	PH4C
City	:	NEW YORK
State	:	NY
Zip	:	10010
Country	:	US
Telephone Number	:	260-602-4096
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 BAINBRIDGE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-2404
Country	:	US
Telephone Number	:	718-920-4428
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2012
Last Update Date	:	04/27/2018

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