MEDICARE: DR. SANGHO KIM DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	N007165	NY

General Provider Information

NPI Number	:	1497252761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANGHO KIM DPM

Provider Business Mailing Address
First Line	:	199 STATE ST
Second Line	:	APT 10B
City	:	BROOKLYN
State	:	NY
Zip	:	11201-8707
Country	:	US
Telephone Number	:	347-467-0266
Fax Number	:

Provider Business Practice Location Address
First Line	:	5908 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-4071
Country	:	US
Telephone Number	:	347-467-0266
Fax Number	:

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

Provider Enumeration Date	:	04/12/2018
Last Update Date	:	06/01/2023

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