Provider Demographics
NPI:1215174941
Name:KIM, KYU-HAN (DO)
Entity type:Individual
Prefix:
First Name:KYU-HAN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:ALLAN
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1 TOWNE CENTRE DRIVE
Mailing Address - Street 2:
Mailing Address - City:CLIFFISDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-1617
Mailing Address - Country:US
Mailing Address - Phone:551-234-3040
Mailing Address - Fax:
Practice Address - Street 1:1 TOWNE CENTRE DRIVE
Practice Address - Street 2:
Practice Address - City:CLIFFISDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010
Practice Address - Country:US
Practice Address - Phone:512-343-0405
Practice Address - Fax:551-234-3034
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-16
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine