Provider Demographics
NPI:1699738096
Name:KIM, DAVID D (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:D
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14316 SANFORD AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2044
Mailing Address - Country:US
Mailing Address - Phone:718-445-1700
Mailing Address - Fax:718-445-1704
Practice Address - Street 1:14316 SANFORD AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2044
Practice Address - Country:US
Practice Address - Phone:718-445-1700
Practice Address - Fax:718-445-1704
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230398207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02511815Medicaid
NY02511815Medicaid
NJ0105TJMedicare ID - Type Unspecified