Provider Demographics
NPI:1942381090
Name:KIM, JAMES N (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:N
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 1:2608 KEISER BLVD
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610
Mailing Address - Country:US
Mailing Address - Phone:610-685-5864
Mailing Address - Fax:610-929-1528
Practice Address - Street 1:2608 KEISER BLVD
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1961
Practice Address - Country:US
Practice Address - Phone:610-685-5864
Practice Address - Fax:610-929-1528
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD428591207RS0012X, 207RC0200X
PAMD-428591207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015530810001Medicaid
PA100269Medicare PIN
PA1015530810001Medicaid