Provider Demographics
NPI:1487633723
Name:KIM, TAIK H (MD)
Entity Type:Individual
Prefix:DR
First Name:TAIK
Middle Name:H
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 1:1020A E BOAL AVE
Mailing Address - Street 2:
Mailing Address - City:BOALSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16827-1509
Mailing Address - Country:US
Mailing Address - Phone:814-237-8627
Mailing Address - Fax:814-238-0083
Practice Address - Street 1:111 MARYS AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-5852
Practice Address - Country:US
Practice Address - Phone:845-339-7700
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1542902085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0885566OtherAETNA USHC
NY2329614OtherAETNA USHC HMO
NY9567121OtherGHI PPO
NYP2548529OtherOXFORD LIBERTY
NY15D911OtherEMPIRE BCBS
NY397001OtherMVP
NY00824153Medicaid
NY397114OtherMVP
NY4336394OtherAETNA USHC PPO
NY0034642OtherGHI
NY13261OtherGHI
NY930711OtherEMPIRE BCBS
NY000470811002OtherBCBS NE NY
NY10038783OtherCDPHP
NY000478081002OtherBCBS NE NY
NYP2548529OtherOXFORD FREEDOM
NY0885566OtherAETNA USHC
NY00824153Medicaid