Provider Demographics
NPI:1861554271
Name:KIM, EUN AE (MD)
Entity type:Individual
Prefix:
First Name:EUN
Middle Name:AE
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:722 YORKLYN RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707-8718
Mailing Address - Country:US
Mailing Address - Phone:302-235-2351
Mailing Address - Fax:302-235-2365
Practice Address - Street 1:722 YORKLYN RD
Practice Address - Street 2:SUITE 400
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-8718
Practice Address - Country:US
Practice Address - Phone:302-235-2351
Practice Address - Fax:302-235-2365
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2009-02-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
DEC10008813207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1861554271Medicaid
DE1305142AHSMedicare Oscar/Certification