Provider Demographics
NPI:1891811535
Name:KIM, ACHIN (MD)
Entity Type:Individual
Prefix:MRS
First Name:ACHIN
Middle Name:
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 1:1928 FOXFIRE CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-1717
Mailing Address - Country:US
Mailing Address - Phone:248-650-8588
Mailing Address - Fax:248-650-8599
Practice Address - Street 1:455 S LIVERNOIS RD
Practice Address - Street 2:SUITE A11
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-2578
Practice Address - Country:US
Practice Address - Phone:248-650-8588
Practice Address - Fax:248-650-8599
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0635629Medicare ID - Type Unspecified
MIC33718Medicare UPIN