1952369548 NPI number — EDWARD KIM MD

Table of content: EDWARD KIM MD (NPI 1952369548)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952369548 NPI number — EDWARD KIM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIM
Provider First Name:
EDWARD
Provider Middle Name:
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:
1952369548
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 COMMUNITY DR
Provider Second Line Business Mailing Address:
ATTN MELINDA TOOMEY
Provider Business Mailing Address City Name:
BUFFALO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14225-2523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-505-5634
Provider Business Mailing Address Fax Number:
716-505-5654

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2401 PARK DR STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17110-9303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-686-9842
Provider Business Practice Location Address Fax Number:
844-803-8108
Provider Enumeration Date:
05/03/2006

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: 207R00000X , with the licence number:  0101275199 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 223349 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: MD471851 , 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: 040426003141 . This is a "FIDELIS CARE # FOR WS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000527458002 . This is a "HEALTH NOW BCBS # FOR WS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000527458003 . This is a "HEALTH NOW BCBS # FOR AU" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 159668BJ . This is a "PREFERRED CARE #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P00249261 . This is a "MEDICARE RAILROAD #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2591880 . This is a "GHI PPO #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00026346202 . This is a "UNIVERA #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0493261 . This is a "IHA #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 040426003139 . This is a "FIDELIS CARE #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 223349-2W . This is a "WORKERS COMP #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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