Provider Demographics
NPI:1427252899
Name:KIM, KAK RAE (MD)
Entity type:Individual
Prefix:DR
First Name:KAK
Middle Name:RAE
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:56-45 MAIN STREET
Mailing Address - Street 2:W-LL300
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5046
Mailing Address - Country:US
Mailing Address - Phone:718-445-0220
Mailing Address - Fax:718-939-1167
Practice Address - Street 1:56-45 MAIN STREET
Practice Address - Street 2:W-LL300
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5046
Practice Address - Country:US
Practice Address - Phone:718-445-0220
Practice Address - Fax:718-939-1167
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2011-04-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY2530862086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00871353OtherRAILROAD
NY03113173Medicaid
NY03113173Medicaid