Basic Information
| Provider Information | |||||||||
| NPI: | 1023051976 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | KYO | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 774 CHRISTIANA RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197134236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026234004 | ||||||||
| FaxNumber: | 3026234064 | ||||||||
| Practice Location | |||||||||
| Address1: | 774 CHRISTIANA RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197134236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026234004 | ||||||||
| FaxNumber: | 3026234064 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | C10000868 | DE | Y | Other Service Providers | Specialist |
No ID Information.