Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 22DI01885700 | NJ |
N | 1223P0700X | Prosthodontist | 045175 | NY |
NPI | 1023219045 |
---|---|
Provider Name | Dr. Sung H Kim |
First Address | Flushing, NY 11354-3884 |
Second Address | Flushing, NY 11354-3884 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2007 |
Last Update Date | 09/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BK4153867 | DEA (01) | NJ |