Kim, Sang Taek
Kim, Sang Taek is an sole proprietor health care provider with primary practice located at 330 Orchard St , New Haven CT 06511-4417. He recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Rheumatology. Allopathic & Osteopathic Physicians / Rheumatology is his primary health care specialty. Kim, Sang Taek can be contacted via phone (203) 680-7050.Contact Information
Primary practice address
330 Orchard St
New Haven CT 06511-4417
Phone: (203) 680-7050
Fax: (203) 785-7053
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Student, Health Care / Student in an Organized Health Care Education/Training Program | 390200000X | ||
| Allopathic & Osteopathic Physicians / Rheumatology | 207RR0500X | 047978 | Connecticut |
| Allopathic & Osteopathic Physicians / Rheumatology | 207RR0500X | Q6526 | Texas |
Profile Details
| NPI number | 1174753172 |
|---|---|
| LBN Legal business name | Kim, Sang Taek |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 24th, 2009 |
| Last updated | May 10th, 2023 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1174753172 | NPPES |
| Texas | MEDICAID | 354544401 | |
| Texas | Other | 354544402 |
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