MEDICARE: KYUNG KIM

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	171400000X	Health & Wellness Coach	458839	PA

General Provider Information

NPI Number	:	1629892815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYUNG KIM

Provider Business Mailing Address
First Line	:	1135 W CHELTENHAM AVE STE 205
Second Line	:
City	:	ELKINS PARK
State	:	PA
Zip	:	19027-3008
Country	:	US
Telephone Number	:	215-260-5828
Fax Number	:	215-635-7501

Provider Business Practice Location Address
First Line	:	1135 W CHELTENHAM AVE STE 205
Second Line	:
City	:	ELKINS PARK
State	:	PA
Zip	:	19027-3008
Country	:	US
Telephone Number	:	215-635-7500
Fax Number	:	215-635-7501

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

Provider Enumeration Date	:	11/13/2024
Last Update Date	:	11/13/2024

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Directions to “ KYUNG KIM ” Practice Location

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