Provider Demographics
NPI:1366537375
Name:KAY, KIHONG (OD)
Entity type:Individual
Prefix:DR
First Name:KIHONG
Middle Name:
Last Name:KAY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 LONG LN
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-2507
Mailing Address - Country:US
Mailing Address - Phone:610-352-2844
Mailing Address - Fax:
Practice Address - Street 1:51 LONG LN
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-2507
Practice Address - Country:US
Practice Address - Phone:610-352-2844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000889152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01679483Medicaid
PAU63769Medicare UPIN