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NPI Code Detail

MEDICARE: YAEWON KIM

MEDICARE: YAEWON KIM
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1255270575
Entity Type Code : Individual
Provider Name (Legal Business Name) : YAEWON KIM
Provider Business Mailing Address
First Line : 1351 WASHINGTON BLVD
Second Line :
City : STAMFORD
State : CT
Zip : 06902-2419
Country : US
Telephone Number : 203-621-3700
Fax Number : 203-621-3710
Provider Business Practice Location Address
First Line : 1351 WASHINGTON BLVD
Second Line :
City : STAMFORD
State : CT
Zip : 06902-2419
Country : US
Telephone Number : 203-621-3700
Fax Number : 203-621-3710
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2026
Last Update Date : 03/25/2026

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Directions to “ YAEWON KIM ” Practice Location

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