Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0102X | Surgical Critical Care | MD066657L | PA |
Y | 2086S0127X | Trauma Surgeon | MD066657L | PA |
NPI | 1205866860 |
---|---|
Provider Name | Patrick K Kim |
First Address | Philadelphia, PA 19104-2640 |
Second Address | Philadelphia, PA 19104-2640 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 06/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0019498000001 | (05) | PA |
H82080 | (02) |