MEDICARE: DR. CHUNG EUN P 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	174400000X	Specialist	119172	NY

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

General Provider Information

NPI Number	:	1568561371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHUNG EUN P KIM M.D.

Provider Business Mailing Address
First Line	:	18 HARBOR LN
Second Line	:
City	:	RYE
State	:	NY
Zip	:	10580-2213
Country	:	US
Telephone Number	:	914-381-5001
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 N 7TH AVE
Second Line	:
City	:	MT VERNON
State	:	NY
Zip	:	10550-2026
Country	:	US
Telephone Number	:	914-664-8000
Fax Number	:

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

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	07/08/2007

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