Provider Demographics
NPI:1366552390
Name:KIM, CELL (DO)
Entity type:Individual
Prefix:
First Name:CELL
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 S FILBERT ST
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-6539
Mailing Address - Country:US
Mailing Address - Phone:717-795-6656
Mailing Address - Fax:
Practice Address - Street 1:409 S 2ND ST
Practice Address - Street 2:SUITE 3F
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17104-1612
Practice Address - Country:US
Practice Address - Phone:717-230-3459
Practice Address - Fax:717-230-3460
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003972L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB95810Medicare UPIN