Provider Demographics
NPI:1366514275
Name:KIM, IN-SOON (MD)
Entity type:Individual
Prefix:
First Name:IN-SOON
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 W TRENTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19067-3516
Mailing Address - Country:US
Mailing Address - Phone:215-736-9500
Mailing Address - Fax:215-736-2779
Practice Address - Street 1:801 W TRENTON AVENUE
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:PA
Practice Address - Zip Code:19067-3516
Practice Address - Country:US
Practice Address - Phone:215-736-9500
Practice Address - Fax:215-736-2779
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039079L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
P2445432OtherOXFORD
4276503OtherAETNA
PA1074081Medicaid
488663Medicare ID - Type Unspecified
PA1074081Medicaid