MEDICARE: ANTHONY H KIM MD

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	2084P0800X	Psychiatry Physician	165964	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154363109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY H KIM MD

Provider Business Mailing Address
First Line	:	2155 STATE ROUTE 22B
Second Line	:
City	:	MORRISONVILLE
State	:	NY
Zip	:	12962-3417
Country	:	US
Telephone Number	:	518-563-8000
Fax Number	:	518-563-9001

Provider Business Practice Location Address
First Line	:	2155 STATE ROUTE 22B
Second Line	:
City	:	MORRISONVILLE
State	:	NY
Zip	:	12962-3417
Country	:	US
Telephone Number	:	518-563-8000
Fax Number	:	518-563-9001

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

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	12/26/2012

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