Provider Demographics
NPI:1881626448
Name:KIM, INKWIY (MD)
Entity type:Individual
Prefix:
First Name:INKWIY
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 1:1064 E MAIN ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-4898
Mailing Address - Country:US
Mailing Address - Phone:203-235-3345
Mailing Address - Fax:203-235-5658
Practice Address - Street 1:1064 E MAIN ST
Practice Address - Street 2:SUITE 302
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-4898
Practice Address - Country:US
Practice Address - Phone:203-235-3345
Practice Address - Fax:203-235-5658
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT018027207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060864650OtherUNITED HEALTHCARE
CT010018027CT01OtherANTHEM
CT4539436OtherAETNA
CTORO204OtherHEALTHNET
CT060864650OtherCIGNA
CT0180275663OtherCONNECTICARE
CTP381429OtherOXFORD
CT001180272Medicaid
CT0180275663OtherCONNECTICARE
CT060864650OtherCIGNA
040000136Medicare PIN