Provider Demographics
NPI:1255468690
Name:KIM, LARRY INLIP (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:INLIP
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 1:701 E MARSHALL STREET
Mailing Address - Street 2:NRW 141
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19380-4412
Mailing Address - Country:US
Mailing Address - Phone:610-431-5472
Mailing Address - Fax:
Practice Address - Street 1:701 E MARSHALL STREET
Practice Address - Street 2:NRW 141
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19380-4412
Practice Address - Country:US
Practice Address - Phone:610-431-5472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD429858207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30042528OtherKEYSTONE MERCY
PA821632Other1ST HEALTH PRIORIT
PA000000213102OtherUNISON
PA1018981970001Medicaid
PA1957622OtherHIGHMARK
PA2849064000OtherIBC
PA50070417OtherCAPITAL ADVANTAGE
PA20062997OtherAMERIHEALTH MERCY
PA1018981970001Medicaid