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General NPI Number Information
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NPI Number | 1023126828
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Entity Type | Organization
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Legal Business Name | HYUNG-BAE KIM MD PC
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 545 N RIVER ST SUITE 210
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City | WILKES BARRE
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State | PA
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Zip | 18702-2600
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Country | US
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Telephone | 570-823-1169
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Fax | 570-823-2468
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Provider Business Mailing Address
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Address Line | 545 N RIVER ST SUITE 210
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City | WILKES BARRE
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State | PA
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Zip | 18702-2600
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Country | US
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Telephone | 570-823-1169
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Fax | 570-823-2468
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Authorized Official
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Title or Position | MD
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Name | MR. HYUNG-BAE KIM
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Credential | MD
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Telephone | 570-823-1169
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD019119E
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License Number State | PA
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