Provider Demographics
NPI:1699864959
Name:KIM, KYOUNG S (MD)
Entity type:Individual
Prefix:DR
First Name:KYOUNG
Middle Name:S
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:169 NORTH PLANK ROAD
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550
Mailing Address - Country:US
Mailing Address - Phone:845-561-6191
Mailing Address - Fax:845-561-4145
Practice Address - Street 1:169 NORTH PLANK ROAD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550
Practice Address - Country:US
Practice Address - Phone:845-561-6191
Practice Address - Fax:845-561-4145
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143328207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00510114060Medicaid
NY35A231Medicare PIN
C08980Medicare UPIN