Provider Demographics
NPI:1356336937
Name:KIM, JOOHYONG HENRY (MD)
Entity type:Individual
Prefix:
First Name:JOOHYONG
Middle Name:HENRY
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 1:200 BANNING ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904
Mailing Address - Country:US
Mailing Address - Phone:302-736-1320
Mailing Address - Fax:302-736-0769
Practice Address - Street 1:200 BANNING ST
Practice Address - Street 2:SUITE 250
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904
Practice Address - Country:US
Practice Address - Phone:302-736-1320
Practice Address - Fax:302-736-0769
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DECI-005018208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE000785501Medicaid
G54902Medicare UPIN
DE000785501Medicaid