Healthcare Provider Details

I. General information

NPI: 1205730702
Provider Name (Legal Business Name): LYDIA KIM MSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 BELMONT AVE APT 102
BALA CYNWYD PA
19004-2409
US

IV. Provider business mailing address

50 BELMONT AVE APT 102
BALA CYNWYD PA
19004-2409
US

V. Phone/Fax

Practice location:
  • Phone: 267-475-3301
  • Fax:
Mailing address:
  • Phone: 267-475-3301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: