Provider Demographics
NPI:1295727873
Name:KIM, DAVID D (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:D
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1201 NOTT ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308-2589
Mailing Address - Country:US
Mailing Address - Phone:518-374-3123
Mailing Address - Fax:518-374-9711
Practice Address - Street 1:1201 NOTT ST
Practice Address - Street 2:SUITE 106
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-2589
Practice Address - Country:US
Practice Address - Phone:518-374-3123
Practice Address - Fax:518-374-9711
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2011-01-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY177315-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
040426006649OtherFIDELIS
110160500OtherUS DEPT OF LABOR
000000085413OtherGHI HMO
10001061OtherCDPHP
000405016001OtherBLUE SHIELD NENY
177315-1OtherTRICARE NORTH REGION
9715959OtherGHI
000405016002OtherBLUE SHIELD NENY
NY01273418Medicaid
33588KOtherFIDELIS MEDICARE
E42294OtherAMERICAN PROGRESSIVE TODA
05155OtherMVP
CAN1773159OtherNO FAULT
CAN1773159OtherWORKERS COMP
DK094V4110OtherEMPIRE BLUE CROSS
DK094V4120OtherEMPIRE BLUE CROSS
05155OtherMVP
DK094V4120OtherEMPIRE BLUE CROSS
NY01273418Medicaid