1174721815 NPI number — JUNESUG PETER KIM

Table of content: MICHAEL DANIEL MCGRATH MD (NPI 1619613643)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174721815 NPI number — JUNESUG PETER KIM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIM
Provider First Name:
JUNESUG
Provider Middle Name:
PETER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

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:
1174721815
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2550 THOMAS STREET, #22
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MISSISSAUGA
Provider Business Mailing Address State Name:
ONTARIO
Provider Business Mailing Address Postal Code:
L5M 5N8
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
905-285-0213
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 LAWRENCE AVE WEST, SUITE 362
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TORONTO
Provider Business Practice Location Address State Name:
ONTARIO
Provider Business Practice Location Address Postal Code:
M6A 3B4
Provider Business Practice Location Address Country Code:
CA
Provider Business Practice Location Address Telephone Number:
416-785-9230
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/04/2007

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: 225X00000X , with the licence number:  9445 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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