Provider Demographics
NPI:1962574236
Name:KIM, MIKYUM (MD)
Entity type:Individual
Prefix:DR
First Name:MIKYUM
Middle Name:
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 1:4 PARK AVE
Mailing Address - Street 2:#20G
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:212-683-2165
Mailing Address - Fax:212-532-1360
Practice Address - Street 1:4 PARK AVE
Practice Address - Street 2:#20G
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-683-2165
Practice Address - Fax:212-532-1360
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1302232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY32A671Medicare ID - Type Unspecified