Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 220814 | NY |
Y | 2081P2900X | Pain Medicine | 220814 | NY |
NPI | 1295718351 |
---|---|
Provider Name | Dr. Charles Kim |
First Address | New York, NY 10016-2772 |
Second Address | New York, NY 10016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2005 |
Last Update Date | 05/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02566407 | (05) | NY |
I06034 | (02) | NY |