Provider Demographics
NPI:1982612545
Name:KIM, JUDITH C (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:C
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3805 W CHESTER PIKE
Mailing Address - Street 2:BUILDING D, SUITE 120
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-2329
Mailing Address - Country:US
Mailing Address - Phone:610-550-3000
Mailing Address - Fax:610-550-3079
Practice Address - Street 1:3805 W CHESTER PIKE
Practice Address - Street 2:BUILDING D, SUITE 120
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-2329
Practice Address - Country:US
Practice Address - Phone:610-550-3000
Practice Address - Fax:610-550-3079
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD423500207ZD0900X, 207ZP0102X
DEC1-0008681207ZD0900X
NJ25MA07865400207ZD0900X
NY231971207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I49028Medicare UPIN