Provider Demographics
NPI:1952369548
Name:KIM, EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
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 1:7 COMMUNITY DR
Mailing Address - Street 2:ATTN MELINDA TOOMEY
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14225-2523
Mailing Address - Country:US
Mailing Address - Phone:716-505-5634
Mailing Address - Fax:716-505-5654
Practice Address - Street 1:2401 PARK DR STE 101
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-9303
Practice Address - Country:US
Practice Address - Phone:717-686-9842
Practice Address - Fax:844-803-8108
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101275199207R00000X
NY223349207R00000X
PAMD471851207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY040426003141OtherFIDELIS CARE # FOR WS
NY000527458002OtherHEALTH NOW BCBS # FOR WS
NY000527458003OtherHEALTH NOW BCBS # FOR AU
NY159668BJOtherPREFERRED CARE #
NYP00249261OtherMEDICARE RAILROAD #
NY2591880OtherGHI PPO #
NY00026346202OtherUNIVERA #
NY0493261OtherIHA #
NY040426003139OtherFIDELIS CARE #
NY223349-2WOtherWORKERS COMP #
NYP00249261OtherMEDICARE RAILROAD #
NYDD6748Medicare ID - Type Unspecified