Provider Demographics
NPI:1245266840
Name:BUSH-UY, KIMBERLY (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:BUSH-UY
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 1:4607 MACCORKLE AVE SW
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1364
Mailing Address - Country:US
Mailing Address - Phone:606-679-8391
Mailing Address - Fax:606-678-4033
Practice Address - Street 1:4607 MACCORKLE AVE SW
Practice Address - Street 2:SUITE 201
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1364
Practice Address - Country:US
Practice Address - Phone:606-679-8391
Practice Address - Fax:606-678-4033
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34109207V00000X
WV23879207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY07-00720OtherUNITED HEALTHCARE PROVIDE
KY0771002Medicare ID - Type Unspecified
KY000000222248OtherANTHEM PROVIDER NUMBER
KYH47247Medicare UPIN
KY64034705Medicaid