MEDICARE: DR. YOONSUNG KIM O.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	152W00000X	Optometrist	TUV004298	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	:	1982600185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YOONSUNG KIM O.D.

Provider Business Mailing Address
First Line	:	310 5TH AVE
Second Line	:	FLOOR 2
City	:	NEW YORK
State	:	NY
Zip	:	10001-3605
Country	:	US
Telephone Number	:	212-971-0911
Fax Number	:	212-714-2097

Provider Business Practice Location Address
First Line	:	310 5TH AVE
Second Line	:	FLOOR 2
City	:	NEW YORK
State	:	NY
Zip	:	10001-3605
Country	:	US
Telephone Number	:	212-971-0911
Fax Number	:	212-714-2097

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	02/22/2016

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