Provider Demographics
NPI:1447316161
Name:URI MEDICAL SERVICE P.C.
Entity type:Organization
Organization Name:URI MEDICAL SERVICE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PREISDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HO YON
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-886-6677
Mailing Address - Street 1:3505 FARRINGTON ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-2826
Mailing Address - Country:US
Mailing Address - Phone:718-886-6677
Mailing Address - Fax:718-886-1413
Practice Address - Street 1:3505 FARRINGTON ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-2826
Practice Address - Country:US
Practice Address - Phone:718-886-6677
Practice Address - Fax:718-886-1413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1847002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01769319Medicaid
NY01769319Medicaid