Provider Demographics
NPI:1003877580
Name:KIM, NANCY (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4735 OGLETOWN-STANTON RD
Mailing Address - Street 2:SUITE 3302
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713
Mailing Address - Country:US
Mailing Address - Phone:302-623-4144
Mailing Address - Fax:602-623-4147
Practice Address - Street 1:4735 OGLETOWN-STANTON RD
Practice Address - Street 2:SUITE 3302
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713
Practice Address - Country:US
Practice Address - Phone:302-623-4144
Practice Address - Fax:602-623-4147
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC100066912081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE510110596OtherBCBS DE
DE510110596OtherCOVENTRY
DE3295888OtherAETNA
DE2230869000OtherAMERIHEALTH
DE510110596OtherBCBS DE
H93131Medicare UPIN