Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic |
NPI | 1609018241 |
---|---|
Provider Name | Mr. Won Kyu Kim |
First Address | Flushing, NY 11354-4110 |
Second Address | Flushing, NY 11354-4110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2009 |
Last Update Date | 27/03/2009 |