Provider Demographics
NPI:1033157896
Name:KIM, HAN JOO (MD)
Entity type:Individual
Prefix:
First Name:HAN
Middle Name:JOO
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1980 CROMPOND RD
Mailing Address - Street 2:RADIOLOGY DEPARTMENT
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-4179
Mailing Address - Country:US
Mailing Address - Phone:914-734-3945
Mailing Address - Fax:914-734-3678
Practice Address - Street 1:1980 CROMPOND RD
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567-4179
Practice Address - Country:US
Practice Address - Phone:914-734-3945
Practice Address - Fax:914-734-3678
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2025-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1082042085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01073830Medicaid
NY20E881Medicare ID - Type Unspecified
NY01073830Medicaid