Provider Demographics
NPI:1407854797
Name:KIM, ALICE YANG-HEE (MD)
Entity type:Individual
Prefix:DR
First Name:ALICE
Middle Name:YANG-HEE
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14890
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12212-4890
Mailing Address - Country:US
Mailing Address - Phone:518-525-5634
Mailing Address - Fax:518-649-4094
Practice Address - Street 1:1735 ROUTE 9
Practice Address - Street 2:
Practice Address - City:HALFMOON
Practice Address - State:NY
Practice Address - Zip Code:12065-2421
Practice Address - Country:US
Practice Address - Phone:518-458-2000
Practice Address - Fax:518-458-1524
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD13512207RC0000X
NY227785207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC02376341Medicaid
RIAK83696Medicaid
MA110088547AMedicaid
RI002028701OtherMEDICARE PTAN
RIAK83696Medicaid
MA110088547AMedicaid
NYH83323Medicare UPIN