Provider Demographics
NPI:1215173760
Name:HWAOK KIM MD PLLC
Entity type:Organization
Organization Name:HWAOK KIM MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HWAOK
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-436-1620
Mailing Address - Street 1:2735 BUFFALO RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-1337
Mailing Address - Country:US
Mailing Address - Phone:585-436-1620
Mailing Address - Fax:585-527-9049
Practice Address - Street 1:2735 BUFFALO RD
Practice Address - Street 2:SUITE 1
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-1337
Practice Address - Country:US
Practice Address - Phone:585-436-1620
Practice Address - Fax:585-527-9049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-05
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208136207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY101727BJOtherMVP/PREFERRED CARE
NYP01020836OtherEXCELLUS BLUE CROSS/BLUE SHIELD
NYP020208136OtherEXCELLUS HMO'S
NY03118870Medicaid
NYG58593Medicare UPIN
NYJ100000127Medicare PIN