Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 130574 | CA |
NPI | 1093071730 |
---|---|
Provider Name | Dr. Jin Suk Calvin Kim |
First Address | New York, NY 10032-3722 |
Second Address | New York, NY 10032 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2012 |
Last Update Date | 20/07/2016 |