Provider Demographics
NPI:1184613838
Name:KIM, SOO YOON (MD)
Entity type:Individual
Prefix:
First Name:SOO
Middle Name:YOON
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1235 OLD YORK RD
Mailing Address - Street 2:STE G20
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-3839
Mailing Address - Country:US
Mailing Address - Phone:215-517-1250
Mailing Address - Fax:215-517-0821
Practice Address - Street 1:3401 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5103
Practice Address - Country:US
Practice Address - Phone:215-707-7725
Practice Address - Fax:215-707-3945
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-17
Last Update Date:2018-05-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD069981L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019708640001Medicaid
H93924Medicare UPIN
PA0019708640001Medicaid