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NPI Code Detail

MEDICARE: DR. SYUNG SOO KIIM MD

MEDICARE: DR. SYUNG SOO KIIM 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
1207L00000XAnesthesiology Physician1215861NY

Other Identifiers

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

General Provider Information

NPI Number : 1205818028
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SYUNG SOO KIIM MD
Provider Business Mailing Address
First Line : PO BOX 3118
Second Line : 226 E MAIN ST
City : MIDDLETOWN
State : NY
Zip : 10940-0810
Country : US
Telephone Number :
Fax Number : 845-343-6228
Provider Business Practice Location Address
First Line : 60 PROSPECT AVE
Second Line :
City : MIDDLETOWN
State : NY
Zip : 10940-4133
Country : US
Telephone Number : 845-343-6216
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/17/2005
Last Update Date : 07/08/2007

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