Provider Demographics
NPI:1023054202
Name:KIM, SANG H (MD)
Entity type:Individual
Prefix:
First Name:SANG
Middle Name:H
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:630 W 168TH ST # 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3725
Mailing Address - Country:US
Mailing Address - Phone:212-305-9817
Mailing Address - Fax:914-327-2183
Practice Address - Street 1:1086 N BROADWAY STE 240
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1115
Practice Address - Country:US
Practice Address - Phone:914-377-0300
Practice Address - Fax:914-327-2183
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY206338207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P2640511OtherOXFORD
NYP00119072OtherRAILROAD MEDICARE
NY9C3981OtherBCBS
NY02073352Medicaid
0D2653OtherACS HEALTHNET
NYH13518Medicare UPIN
NY61B461Medicare PIN