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NPI Code Detail

MEDICARE: DR. PAUL KIM MD

MEDICARE: DR. PAUL 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
12085R0202XDiagnostic Radiology Physician197623NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
110495675OTHERCAQH #
286Y803K221OTHERNYPTAN

General Provider Information

NPI Number : 1194716027
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PAUL KIM MD
Provider Business Mailing Address
First Line : 1980 CROMPOND RD
Second Line :
City : CORTLANDT MANOR
State : NY
Zip : 10567-4144
Country : US
Telephone Number : 914-737-3935
Fax Number : 914-734-3838
Provider Business Practice Location Address
First Line : 1980 CROMPOND RD
Second Line :
City : CORTLANDT MANOR
State : NY
Zip : 10567-4144
Country : US
Telephone Number : 914-734-3935
Fax Number : 914-734-3838
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2005
Last Update Date : 07/09/2019

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