MEDICARE: DR. ALICE YANG-HEE KIM M.D.

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	207RC0000X	Cardiovascular Disease Physician	MD13512	RI
2	207RC0000X	Cardiovascular Disease Physician	227785	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	002028701	OTHER	RI	MEDICARE PTAN

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407854797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALICE YANG-HEE KIM M.D.

Provider Business Mailing Address
First Line	:	PO BOX 14890
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12212-4890
Country	:	US
Telephone Number	:	518-525-5634
Fax Number	:	518-649-4094

Provider Business Practice Location Address
First Line	:	1735 ROUTE 9
Second Line	:
City	:	HALFMOON
State	:	NY
Zip	:	12065-2421
Country	:	US
Telephone Number	:	518-458-2000
Fax Number	:	518-458-1524

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

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	10/17/2024

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Directions to “ DR. ALICE YANG-HEE KIM M.D.” Practice Location

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