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NPI Code Detail

MEDICARE: DOUGLAS J KIM MD

MEDICARE: DOUGLAS J 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
1207ZP0102XAnatomic Pathology & Clinical Pathology PhysicianQ8089TX
2207ZP0102XAnatomic Pathology & Clinical Pathology Physician248187NY

General Provider Information

NPI Number : 1689835589
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOUGLAS J KIM MD
Provider Business Mailing Address
First Line : 75 BEEKMAN ST
Second Line :
City : PLATTSBURGH
State : NY
Zip : 12901-1427
Country : US
Telephone Number : 518-561-2000
Fax Number :
Provider Business Practice Location Address
First Line : 75 BEEKMAN ST
Second Line :
City : PLATTSBURGH
State : NY
Zip : 12901-1427
Country : US
Telephone Number : 518-561-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2008
Last Update Date : 12/27/2022

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