Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | 273922 | NY |
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 273922 | NY |
NPI | 1548434236 |
---|---|
Provider Name | Sang W Kim |
First Address | East Syracuse, NY 13057-9208 |
Second Address | East Syracuse, NY 13057-9208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2008 |
Last Update Date | 26/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03855896 | (05) | NY |