MEDICARE: ROBIN SUNG-CHANG KIM MD

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	207R00000X	Internal Medicine Physician	218754	NY

General Provider Information

NPI Number	:	1558383398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBIN SUNG-CHANG KIM MD

Provider Business Mailing Address
First Line	:	20 GRAND ST
Second Line	:	FL 3
City	:	WARWICK
State	:	NY
Zip	:	10990-1035
Country	:	US
Telephone Number	:	845-368-5000
Fax Number	:	845-987-5979

Provider Business Practice Location Address
First Line	:	3274 STEINWAY ST
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11103-4006
Country	:	US
Telephone Number	:	718-721-0101
Fax Number	:	718-721-0122

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	12/05/2016

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