Basic Information
| Provider Information | |||||||||
| NPI: | 1003877580 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | NANCY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4735 OGLETOWN-STANTON RD | ||||||||
| Address2: | SUITE 3302 | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 19713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026234144 | ||||||||
| FaxNumber: | 6026234147 | ||||||||
| Practice Location | |||||||||
| Address1: | 4735 OGLETOWN-STANTON RD | ||||||||
| Address2: | SUITE 3302 | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 19713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026234144 | ||||||||
| FaxNumber: | 6026234147 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2006 | ||||||||
| LastUpdateDate: | 06/16/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081P2900X | C10006691 | DE | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 510110596 | 01 | DE | BCBS DE | OTHER | 510110596 | 01 | DE | COVENTRY | OTHER | 3295888 | 01 | DE | AETNA | OTHER | 2230869000 | 01 | DE | AMERIHEALTH | OTHER |