1932194701 NPI number — PHILIP S KIM MD

Table of content: PHILIP S KIM MD (NPI 1932194701)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932194701 NPI number — PHILIP S KIM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIM
Provider First Name:
PHILIP
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1932194701
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
291 CARTER DR STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLETOWN
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19709-5845
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
844-365-7246
Provider Business Mailing Address Fax Number:
844-524-1767

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
931 E HAVERFORD RD STE 202
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRYN MAWR
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19010-3838
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-365-7246
Provider Business Practice Location Address Fax Number:
844-516-0080
Provider Enumeration Date:
09/16/2005

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: 207L00000X , with the licence number:  MD060379L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LP2900X , with the licence number: C1-0006593 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0000X , with the licence number: C1-0006593 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0000X , with the licence number: MD060379L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001613641 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000017122 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".




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