Provider Demographics
NPI:1235158387
Name:KIM, JOHN J (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1501 LANSDOWNE AVE
Mailing Address - Street 2:#209
Mailing Address - City:DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19023-1333
Mailing Address - Country:US
Mailing Address - Phone:610-534-6370
Mailing Address - Fax:610-534-6374
Practice Address - Street 1:1501 LANSDOWNE AVE
Practice Address - Street 2:#209
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-1333
Practice Address - Country:US
Practice Address - Phone:610-534-6370
Practice Address - Fax:610-534-6374
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD035999Y207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
6138OtherAETNA
0053346000OtherKEYSTONE HEALTH PLAN EAST
PA0006886200002Medicaid
0053346000OtherKEYSTONE HEALTH PLAN EAST
PA0006886200002Medicaid