Basic Information
| Provider Information | |||||||||
| NPI: | 1023054202 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | SANG | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 630 W 168TH ST # 4 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100323725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123059817 | ||||||||
| FaxNumber: | 9143272183 | ||||||||
| Practice Location | |||||||||
| Address1: | 1086 N BROADWAY STE 240 | ||||||||
| Address2: | |||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107011115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9143770300 | ||||||||
| FaxNumber: | 9143272183 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2006 | ||||||||
| LastUpdateDate: | 05/25/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 206338 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207UN0901X | 206338 | NY | N | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Cardiology |
ID Information
| ID | Type | State | Issuer | Description | P2640511 | 01 | OXFORD | OTHER | P00119072 | 01 | NY | RAILROAD MEDICARE | OTHER | 9C3981 | 01 | NY | BCBS | OTHER | 02073352 | 05 | NY | MEDICAID | 0D2653 | 01 | ACS HEALTHNET | OTHER |