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1952369548

NPI Code Detail

MEDICARE: EDWARD KIM MD

MEDICARE: EDWARD 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	207R00000X	Internal Medicine Physician	0101275199	VA
2	207R00000X	Internal Medicine Physician	223349	NY
3	207R00000X	Internal Medicine Physician	MD471851	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00249261	OTHER	NY	MEDICARE RAILROAD #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	040426003141	OTHER	NY	FIDELIS CARE # FOR WS
2	000527458002	OTHER	NY	HEALTH NOW BCBS # FOR WS
3	000527458003	OTHER	NY	HEALTH NOW BCBS # FOR AU
4	159668BJ	OTHER	NY	PREFERRED CARE #
6	2591880	OTHER	NY	GHI PPO #
7	00026346202	OTHER	NY	UNIVERA #
8	0493261	OTHER	NY	IHA #
9	040426003139	OTHER	NY	FIDELIS CARE #
10	223349-2W	OTHER	NY	WORKERS COMP #

General Provider Information

NPI Number	:	1952369548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD KIM MD

Provider Business Mailing Address
First Line	:	7 COMMUNITY DR
Second Line	:	ATTN MELINDA TOOMEY
City	:	BUFFALO
State	:	NY
Zip	:	14225-2523
Country	:	US
Telephone Number	:	716-505-5634
Fax Number	:	716-505-5654

Provider Business Practice Location Address
First Line	:	2401 PARK DR STE 101
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17110-9303
Country	:	US
Telephone Number	:	717-686-9842
Fax Number	:	844-803-8108

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	01/23/2023

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Directions to “ EDWARD KIM MD” Practice Location

Language	Start Address	Practice Location

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