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NPI Code Detail

MEDICARE: JEFFREY KIM LLC

MEDICARE: JEFFREY KIM LLC
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
1122300000XDentist044694NY

General Provider Information

NPI Number : 1992939441
Entity Type Code : Organization
Provider Name (Legal Business Name) : JEFFREY KIM LLC
Provider Business Mailing Address
First Line : 400 MIDWAY PARK DR
Second Line :
City : MIDDLETOWN
State : NY
Zip : 10940-2656
Country : US
Telephone Number : 845-344-4336
Fax Number :
Provider Business Practice Location Address
First Line : 400 MIDWAY PARK DR
Second Line :
City : MIDDLETOWN
State : NY
Zip : 10940-2656
Country : US
Telephone Number : 845-344-4336
Fax Number :
Authorized Official
Title or Position : OWNER
Name : JEFFREY KIM
Credential : D.D.S.
Telephone Number : 845-344-4336
Provider Enumeration Date : 05/13/2009
Last Update Date : 05/13/2009

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