Provider Demographics
NPI:1215953773
Name:T.Y. KIM, M.D., P.C.
Entity type:Organization
Organization Name:T.Y. KIM, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTHERLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-966-9787
Mailing Address - Street 1:PO BOX 998
Mailing Address - Street 2:ATTN: RIVERSIDE MANAGEMENT SERVICES ORG
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-0998
Mailing Address - Country:US
Mailing Address - Phone:914-966-9787
Mailing Address - Fax:914-966-9793
Practice Address - Street 1:967 N BROADWAY
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1301
Practice Address - Country:US
Practice Address - Phone:914-966-9787
Practice Address - Fax:914-966-9793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW1U951Medicare PIN