Provider Demographics
NPI:1194835835
Name:KIM, HI SOOK (MD)
Entity Type:Individual
Prefix:MRS
First Name:HI
Middle Name:SOOK
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 1:5438 N LAWRENCE STREET
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120
Mailing Address - Country:US
Mailing Address - Phone:215-224-2111
Mailing Address - Fax:215-224-6452
Practice Address - Street 1:5438 N LAWRENCE STREET
Practice Address - Street 2:ATTN: HI SOOK KIM, MD
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19120
Practice Address - Country:US
Practice Address - Phone:215-224-2111
Practice Address - Fax:215-224-6452
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016901E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0274OtherAETNA
PA03417Medicaid
0646651001OtherKEYSTONE EAST
E63529Medicare UPIN