Provider Demographics
NPI:1770861908
Name:KIM, AMY I
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:I
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4262 OLD WILLIAM PENN HWY
Mailing Address - Street 2:
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668-1936
Mailing Address - Country:US
Mailing Address - Phone:724-325-6010
Mailing Address - Fax:727-327-4690
Practice Address - Street 1:4262 OLD WILLIAM PENN HWY
Practice Address - Street 2:
Practice Address - City:MURRYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15668-1936
Practice Address - Country:US
Practice Address - Phone:724-325-6010
Practice Address - Fax:727-327-4690
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS016176207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine