MEDICARE: YOUNG SOOK 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	2085R0001X	Radiation Oncology Physician	25MA04569000	NJ
2	2085R0001X	Radiation Oncology Physician	1530801	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982641742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOUNG SOOK KIM M.D.

Provider Business Mailing Address
First Line	:	33 CLAUDIA CT
Second Line	:
City	:	TAPPAN
State	:	NY
Zip	:	10983-1936
Country	:	US
Telephone Number	:	845-359-0289
Fax Number	:	845-359-3241

Provider Business Practice Location Address
First Line	:	33 CLAUDIA CT
Second Line	:
City	:	TAPPAN
State	:	NY
Zip	:	10983-1936
Country	:	US
Telephone Number	:	845-359-0289
Fax Number	:	845-359-3241

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

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	03/19/2016

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Directions to “ YOUNG SOOK KIM M.D.” Practice Location

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