Basic Information
Provider Information
NPI: 1336429141
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GOH
FirstName: KING SOON
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 55 WATER STREET
Address2: 2ND FLOOR CRED DEPT
City: NEW YORK
State: NY
PostalCode: 100410010
CountryCode: US
TelephoneNumber: 6466802888
FaxNumber: 5165425556
Practice Location
Address1: 101 PENNSYLVANIA AVENUE
Address2:  
City: BROOKLYN
State: NY
PostalCode: 112072428
CountryCode: US
TelephoneNumber: 7182402000
FaxNumber: 7182402260
Other Information
ProviderEnumerationDate: 08/24/2011
LastUpdateDate: 12/03/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/03/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RR0500X27206WVN Allopathic & Osteopathic PhysiciansInternal MedicineRheumatology
207RR0500X313987NYY Allopathic & Osteopathic PhysiciansInternal MedicineRheumatology

No ID Information.


Home