Provider Demographics
NPI:1477599777
Name:KIM, TONY D H (DPM)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:D H
Last Name:KIM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 N CHELAN AVE
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2025
Mailing Address - Country:US
Mailing Address - Phone:509-662-2970
Mailing Address - Fax:509-665-9808
Practice Address - Street 1:616 N CHELAN AVE
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2025
Practice Address - Country:US
Practice Address - Phone:509-662-2970
Practice Address - Fax:509-665-9808
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000627213ES0131X, 213ER0200X, 213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA480028469OtherPALMETO GBA RAILROAD MEDICARE IND #
WA8235145Medicaid
WA35677OtherWA STATE LABOR AND INDUSTRY
WACS9149OtherPALMETTO GBA RAILROAD MEDICARE GROUP #
WACS9149OtherPALMETTO GBA RAILROAD MEDICARE GROUP #
WAGAB11093Medicare ID - Type UnspecifiedMEDICARE B PROVIDER NUMBE
WA0776840001Medicare NSC