Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 2384301 | NY |
NPI | 1164488508 |
---|---|
Provider Name | Tae Ho Kim |
First Address | New York, NY 10014-6803 |
Second Address | New York, NY 10014-6803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 03/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02729642 | (05) | NY |
F67632 | (02) | NY |