Provider Demographics
NPI:1023126828
Name:HYUNG-BAE KIM MD PC
Entity type:Organization
Organization Name:HYUNG-BAE KIM MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:MR
Authorized Official - First Name:HYUNG-BAE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-823-1169
Mailing Address - Street 1:545 N RIVER ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-2600
Mailing Address - Country:US
Mailing Address - Phone:570-823-1169
Mailing Address - Fax:570-823-2468
Practice Address - Street 1:545 N RIVER ST
Practice Address - Street 2:SUITE 210
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-2600
Practice Address - Country:US
Practice Address - Phone:570-823-1169
Practice Address - Fax:570-823-2468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019119E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1427276OtherBCBS
PA0007414870008Medicaid
208813OtherHEALTH AMERICA
PA815732Other1ST PRIORITY
208813OtherHEALTH AMERICA
C29953Medicare UPIN