Provider Demographics
NPI:1134296841
Name:KIM, DENNIS (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
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 1:1985 LINCOLN WAY SUITE 23
Mailing Address - Street 2:#354
Mailing Address - City:WHITE OAK
Mailing Address - State:PA
Mailing Address - Zip Code:15131-2415
Mailing Address - Country:US
Mailing Address - Phone:412-385-3127
Mailing Address - Fax:
Practice Address - Street 1:1985 LINCOLN WAY SUITE 23
Practice Address - Street 2:#354
Practice Address - City:WHITE OAK
Practice Address - State:PA
Practice Address - Zip Code:15131-2415
Practice Address - Country:US
Practice Address - Phone:412-385-3127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1560652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ22388OtherBCBS
MAJ22388OtherBCBS
G96155Medicare UPIN