MEDICARE: LITTLE NECK RADIOLOGY, P.C.

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	2085R0202X	Diagnostic Radiology Physician	105860	NY

General Provider Information

NPI Number	:	1619194974
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITTLE NECK RADIOLOGY, P.C.

Provider Business Mailing Address
First Line	:	9705 101ST AVE
Second Line	:
City	:	OZONE PARK
State	:	NY
Zip	:	11416-2523
Country	:	US
Telephone Number	:	718-848-0606
Fax Number	:

Provider Business Practice Location Address
First Line	:	9705 101ST AVE
Second Line	:
City	:	OZONE PARK
State	:	NY
Zip	:	11416-2523
Country	:	US
Telephone Number	:	718-848-0606
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. SUNG UK KIM
Credential	:	M.D.
Telephone Number	:	718-848-0606

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	01/29/2008

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