Individual
SUNG JO KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
260 PATCHOGUE YAPHANK RD, STE F, EAST PATCHOGUE, NY 11772-4886
(631) 654-8755
(631) 654-8709
Mailing address
260 PATCHOGUE YAPHANK RD, STE F, EAST PATCHOGUE, NY 11772-4886
(631) 654-8755
(631) 654-8709
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
121585
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00228217
—
NY
01
—
W38231
MEDICARE GROUP NUMBER
—
Enumeration date
12/07/2005
Last updated
04/28/2008
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