| Premier Family Medicine Pc | |
|
86-35 Queens Blvd 1-e Elmhurst NY 11373 | |
| (718) 205-4544 | |
| (718) 205-5594 |
| Full Name | Premier Family Medicine Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 86-35 Queens Blvd, Elmhurst, New York |
| Authorized Official Name and Position | Yong R Kim (PRESIDENT) |
| Authorized Official Contact | 7182054544 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premier Family Medicine Pc 86-35 Queens Blvd 1-e Elmhurst NY 11373 Ph: (718) 205-4544 | Premier Family Medicine Pc 86-35 Queens Blvd 1-e Elmhurst NY 11373 Ph: (718) 205-4544 |
| NPI Number | 1225228778 |
|---|---|
| Provider Enumeration Date | 07/31/2007 |
| Last Update Date | 01/25/2013 |
| Medicare PECOS PAC ID | 0941288757 |
|---|---|
| Medicare Enrollment ID | O20040708001457 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225228778 | NPI | - | NPPES |
| 06378 | Other | NY | GHI-MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 209364 (New York) | Primary |
| Provider Name | Yong Rak Kim |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629067483 PECOS PAC ID: 4486632205 Enrollment ID: I20040708001478 |
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