MEDICARE: DR. ALBERT N 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	208800000X	Urology Physician	1676611	NY

General Provider Information

NPI Number	:	1548234156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALBERT N KIM M.D.

Provider Business Mailing Address
First Line	:	1500 ROUTE 112 BLDG 4
Second Line	:
City	:	PORT JEFFERSON STATION
State	:	NY
Zip	:	11776-8055
Country	:	US
Telephone Number	:	631-751-3000
Fax Number	:	631-509-6559

Provider Business Practice Location Address
First Line	:	2500 NESCONSET HWY BLDG 21A
Second Line	:
City	:	STONY BROOK
State	:	NY
Zip	:	11790-2598
Country	:	US
Telephone Number	:	631-751-3000
Fax Number	:	631-509-6559

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

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	01/17/2020

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