1790880599 NPI number — TAIK-KUN KIM M.D.

Table of content: TAIK-KUN KIM M.D. (NPI 1790880599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790880599 NPI number — TAIK-KUN KIM M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIM
Provider First Name:
TAIK-KUN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790880599
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
VA PITTSBURGH HEALTHCARE SYSTEM, UNIVERSITY DRIVE
Provider Second Line Business Mailing Address:
RADIOLOGY PROGRAM (132X-U)
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-360-3314
Provider Business Mailing Address Fax Number:
412-360-6686

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
322 E ANTIETAM ST STE 106
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAGERSTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21740-5736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-739-6147
Provider Business Practice Location Address Fax Number:
301-739-6163
Provider Enumeration Date:
09/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085N0700X , with the licence number:  51367-20 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: D78778 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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