Provider Demographics
NPI:1215110671
Name:KIM, PEONY Y
Entity type:Individual
Prefix:
First Name:PEONY
Middle Name:Y
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11011 QUEENS BLVD APT 6N
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5403
Mailing Address - Country:US
Mailing Address - Phone:212-348-7400
Mailing Address - Fax:212-348-4286
Practice Address - Street 1:1675 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-3773
Practice Address - Country:US
Practice Address - Phone:212-348-7400
Practice Address - Fax:212-348-4286
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY34143183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist