Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0117X | Orthopaedic Spine Surgeon | 2011003933 | MO |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 246398 | NY |
NPI | 1376710665 |
---|---|
Provider Name | Dr. Han Jo Kim |
First Address | New York, NY 10087-9234 |
Second Address | New York, NY 10021-4823 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2008 |
Last Update Date | 12/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03561520 | (05) | NY |