| NPI | 1073906152 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SONJONG KIM Owner 646-753-2092 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NY NY003506) |
| Enumeration Date | 2015-03-12 |
| Last Update Date | 2015-03-12 |