1316960560 NPI number — HEAKYUNG KIM M.D.

Table of content: HEAKYUNG KIM M.D. (NPI 1316960560)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316960560 NPI number — HEAKYUNG KIM M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIM
Provider First Name:
HEAKYUNG
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316960560
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
180 FORT WASHINGTON AVE
Provider Second Line Business Mailing Address:
HARKNESS PAVILION - SUITE 199
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10032-3722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-305-5337
Provider Business Mailing Address Fax Number:
212-342-3138

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
180 FORT WASHINGTON AVE
Provider Second Line Business Practice Location Address:
HARKNESS PAVILION - SUITE 199
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10032-3722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-305-5337
Provider Business Practice Location Address Fax Number:
212-342-3138
Provider Enumeration Date:
07/26/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2081P0010X , with the licence number:  2596441 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X , with the licence number: 259644 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7591705 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001697740 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01824964 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".