Provider Demographics
NPI:1295726438
Name:KIM, BENEDICT Y (DO)
Entity type:Individual
Prefix:
First Name:BENEDICT
Middle Name:Y
Last Name:KIM
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:P.O. BOX 72384
Mailing Address - Street 2:RADIOLOGY ASSOCIATES OF CANTON, INC.
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44192
Mailing Address - Country:US
Mailing Address - Phone:888-686-1837
Mailing Address - Fax:330-686-5928
Practice Address - Street 1:2600 6TH ST SW
Practice Address - Street 2:RADIOLOGY ASSOCIATES OF CANTON, INC
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710-1702
Practice Address - Country:US
Practice Address - Phone:330-363-2842
Practice Address - Fax:330-580-5536
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2011-01-05
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Provider Licenses
StateLicense IDTaxonomies
OH34 0063802085R0202X, 2085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2134694Medicaid
OH300119316OtherRAILROAD MEDICARE
OH2134694Medicaid
OH4033464Medicare PIN