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NPI Code Detail

MEDICARE: BOO KYUNG KIM PA-C

MEDICARE: BOO KYUNG KIM PA-C
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
1363A00000XPhysician Assistant085.008925IL
2363A00000XPhysician Assistant030663NY

General Provider Information

NPI Number : 1285376749
Entity Type Code : Individual
Provider Name (Legal Business Name) : BOO KYUNG KIM PA-C
Provider Business Mailing Address
First Line : 1027 46TH AVE
Second Line :
City : LONG ISLAND CITY
State : NY
Zip : 11101-5245
Country : US
Telephone Number : 212-385-3700
Fax Number :
Provider Business Practice Location Address
First Line : 1027 46TH AVE
Second Line :
City : LONG ISLAND CITY
State : NY
Zip : 11101-5245
Country : US
Telephone Number : 212-385-3700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2022
Last Update Date : 01/12/2024

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Directions to “ BOO KYUNG KIM PA-C” Practice Location

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