Basic Information
| Provider Information | |||||||||
| NPI: | 1730706714 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | TAEWOO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 N PARK RD APT 1143 | ||||||||
| Address2: | |||||||||
| City: | WYOMISSING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196103049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2243813957 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2500 BERNVILLE RD | ||||||||
| Address2: | |||||||||
| City: | READING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196059453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103782000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2020 | ||||||||
| LastUpdateDate: | 06/25/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MT221902 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.