Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 006777 | NY |
NPI | 1053717629 |
---|---|
Provider Name | Sooji Kim |
First Address | Tappan, NY 10983-2620 |
Second Address | New York, NY 10279-1810 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2014 |
Last Update Date | 14/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006777 | LICENSE (01) | NY |
04524594 | (05) | NY |