Provider Demographics
NPI:1699708867
Name:PLASTIC & RECONSTRUCTIVE SURGERY OF CHESTER COUNTY
Entity type:Organization
Organization Name:PLASTIC & RECONSTRUCTIVE SURGERY OF CHESTER COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-524-8244
Mailing Address - Street 1:460 CREAMERY WAY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2533
Mailing Address - Country:US
Mailing Address - Phone:610-524-8244
Mailing Address - Fax:610-524-1182
Practice Address - Street 1:460 CREAMERY WAY
Practice Address - Street 2:SUITE 110
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2533
Practice Address - Country:US
Practice Address - Phone:610-524-8244
Practice Address - Fax:610-524-1182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA022251Medicare ID - Type Unspecified