Basic Information
| Provider Information | |||||||||
| NPI: | 1669478905 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KYE | ||||||||
| FirstName: | YOUNG | ||||||||
| MiddleName: | HUN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6809 174TH ST | ||||||||
| Address2: | |||||||||
| City: | FRESH MEADOWS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113653408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018042800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11011 72ND AVE | ||||||||
| Address2: | |||||||||
| City: | FOREST HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113754946 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5163587210 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2005 | ||||||||
| LastUpdateDate: | 03/31/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | A117598-1 | NY | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 00218328 | 05 | NY | MEDICAID |