Provider Demographics
NPI:1295804052
Name:KIM, JOSEPH (MD)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
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 1:800 ROSE ST
Mailing Address - Street 2:GENERAL SURGERY - C224
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536
Mailing Address - Country:US
Mailing Address - Phone:859-323-8920
Mailing Address - Fax:859-323-6840
Practice Address - Street 1:800 ROSE ST
Practice Address - Street 2:GENERAL SURGERY - C224
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536
Practice Address - Country:US
Practice Address - Phone:859-323-8920
Practice Address - Fax:859-323-6840
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2803632086X0206X
KY514132086X0206X
CAA82485208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400128758Medicare UPIN