Healthcare Provider Details

I. General information

NPI: 1982612545
Provider Name (Legal Business Name): JUDITH C. KIM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 10/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 W CHESTER PIKE BUILDING D, SUITE 120
NEWTOWN SQUARE PA
19073-2329
US

IV. Provider business mailing address

3805 W CHESTER PIKE BUILDING D, SUITE 120
NEWTOWN SQUARE PA
19073-2329
US

V. Phone/Fax

Practice location:
  • Phone: 610-550-3000
  • Fax: 610-550-3079
Mailing address:
  • Phone: 610-550-3000
  • Fax: 610-550-3079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberMD423500
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD423500
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberC1-0008681
License Number StateDE
# 4
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number25MA07865400
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number231971
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: