Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086X0206X | Surgical Oncologist | 25MA07917300 | NJ |
Y | 2086X0206X | Surgical Oncologist | 69482 | CT |
NPI | 1235217985 |
---|---|
Provider Name | Isaac Y Kim |
First Address | New Haven, CT 06519-1304 |
Second Address | New Haven, CT 06519-1369 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 28/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0072648 | (05) | NJ |
H98112 | (02) | NJ |