Kim, Taesoo

Kim, Taesoo is an individual health care provider with primary practice located at 124 Main St , Massena NY 13662-1916. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Kim, Taesoo can be contacted via phone (315) 769-3559.

Contact Information

Primary practice address
124 Main St Massena NY 13662-1916
Phone: (315) 769-3559
Fax: (315) 769-3550
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 1135161 New York

Profile Details

NPI number 1750348074
LBN Legal business name Kim, Taesoo
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 28th, 2006
Last updated Jul 8th, 2007 - about 18 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1750348074 NPPES
New York MEDICAID 00623556

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