Basic Information
| Provider Information | |||||||||
| NPI: | 1487633723 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | TAIK | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1020A E BOAL AVE | ||||||||
| Address2: | |||||||||
| City: | BOALSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 168271509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142378627 | ||||||||
| FaxNumber: | 8142380083 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 MARYS AVE | ||||||||
| Address2: | |||||||||
| City: | KINGSTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 124015852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453397700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2006 | ||||||||
| 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 | 2085R0001X | 154290 | NY | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 0885566 | 01 | NY | AETNA USHC | OTHER | 2329614 | 01 | NY | AETNA USHC HMO | OTHER | 9567121 | 01 | NY | GHI PPO | OTHER | P2548529 | 01 | NY | OXFORD LIBERTY | OTHER | 15D911 | 01 | NY | EMPIRE BCBS | OTHER | 397001 | 01 | NY | MVP | OTHER | 00824153 | 05 | NY | MEDICAID | 397114 | 01 | NY | MVP | OTHER | 4336394 | 01 | NY | AETNA USHC PPO | OTHER | 0034642 | 01 | NY | GHI | OTHER | 13261 | 01 | NY | GHI | OTHER | 930711 | 01 | NY | EMPIRE BCBS | OTHER | 000470811002 | 01 | NY | BCBS NE NY | OTHER | 10038783 | 01 | NY | CDPHP | OTHER | 000478081002 | 01 | NY | BCBS NE NY | OTHER | P2548529 | 01 | NY | OXFORD FREEDOM | OTHER |