Provider Demographics
NPI:1437151438
Name:KIM, SIE HYON (MD)
Entity type:Individual
Prefix:DR
First Name:SIE
Middle Name:HYON
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E 34TH ST
Mailing Address - Street 2:#211R
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4901
Mailing Address - Country:US
Mailing Address - Phone:212-263-6338
Mailing Address - Fax:212-263-1193
Practice Address - Street 1:400 E 34TH ST
Practice Address - Street 2:#211R
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4901
Practice Address - Country:US
Practice Address - Phone:212-263-6338
Practice Address - Fax:212-263-1193
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146713208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00779864Medicaid
NY00779864Medicaid
NYB79592Medicare UPIN