Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 211856 | NY |
NPI | 1366403982 |
---|---|
Provider Name | Alice Kim |
First Address | Hartford, CT 06150-2594 |
Second Address | New York, NY 10024-5116 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H99580 | (02) | NY |