Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | 166080 | NY |
NPI | 1417936212 |
---|---|
Provider Name | Chun Kim |
First Address | East Meadow, NY 11554-1724 |
Second Address | New York, NY 10029 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2006 |
Last Update Date | 03/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01045216 | (05) | NY |
A60369 | (02) | NY |