Individual
TAEWAN KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
140 W 6TH ST STE LL30, OSWEGO, NY 13126-2564
(315) 349-5511
(315) 349-5921
Mailing address
110 W 6TH ST, OSWEGO, NY 13126-2507
(315) 349-5511
(315) 349-5921
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
220630
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02155824
—
NY
01
—
P02005039
RAILROAD MEDICARE
NY
Enumeration date
05/16/2006
Last updated
03/29/2023
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