MEDICARE: LARRY INLIP KIM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	MD429858	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	30042528	OTHER	PA	KEYSTONE MERCY
2	821632	OTHER	PA	1ST HEALTH PRIORIT
3	000000213102	OTHER	PA	UNISON
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	1957622	OTHER	PA	HIGHMARK
6	2849064000	OTHER	PA	IBC
7	50070417	OTHER	PA	CAPITAL ADVANTAGE
8	20062997	OTHER	PA	AMERIHEALTH MERCY

General Provider Information

NPI Number	:	1255468690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY INLIP KIM MD

Provider Business Mailing Address
First Line	:	701 E MARSHALL STREET
Second Line	:	NRW 141
City	:	PHILADELPHIA
State	:	PA
Zip	:	19380-4412
Country	:	US
Telephone Number	:	610-431-5472
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 E MARSHALL STREET
Second Line	:	NRW 141
City	:	PHILADELPHIA
State	:	PA
Zip	:	19380-4412
Country	:	US
Telephone Number	:	610-431-5472
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	07/23/2021

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Directions to “ LARRY INLIP KIM MD” Practice Location

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