Provider Demographics
NPI:1437199502
Name:KIM, WON MYUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:WON
Middle Name:MYUNG
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 1:6705 OLD YORK RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19126-2841
Mailing Address - Country:US
Mailing Address - Phone:215-224-2000
Mailing Address - Fax:215-224-8651
Practice Address - Street 1:6705 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19126-2841
Practice Address - Country:US
Practice Address - Phone:215-224-2000
Practice Address - Fax:215-224-8651
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032721L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01568368Medicaid
PA0000137299Medicare ID - Type Unspecified
PA01568368Medicaid