Provider Demographics
NPI:1083654214
Name:KIM, WON HEE (MD)
Entity Type:Individual
Prefix:
First Name:WON HEE
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 FLORENCE AVE APT 914N
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2613
Mailing Address - Country:US
Mailing Address - Phone:215-342-2015
Mailing Address - Fax:215-342-0360
Practice Address - Street 1:309 FLORENCE AVE APT 914N
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-2613
Practice Address - Country:US
Practice Address - Phone:215-342-2015
Practice Address - Fax:215-342-0360
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD421134207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA085084Medicare PIN
PAI01430Medicare UPIN