Individual
AE CHAN KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
43 TWEED BLVD, NYACK,, NY 10960
(845) 634-1799
(845) 358-6604
Mailing address
43 TWEED BLVD, NYACK,, NY 10960
(845) 634-1799
(845) 358-6604
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
117579
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00218277
—
NY
01
—
117579
LICENSE
NY
Enumeration date
09/27/2006
Last updated
07/08/2007
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