Provider Demographics
NPI:1932258605
Name:KIM, WOOJIN (MD)
Entity type:Individual
Prefix:DR
First Name:WOOJIN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:WOO
Other - Middle Name:JIN
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3400 SPRUCE ST.
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:55344-5349
Mailing Address - Country:US
Mailing Address - Phone:215-662-3005
Mailing Address - Fax:215-662-7011
Practice Address - Street 1:604 S WASHINGTON SQ
Practice Address - Street 2:UNIT 2211
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-4118
Practice Address - Country:US
Practice Address - Phone:215-554-4956
Practice Address - Fax:215-662-7011
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4294942085R0202X
NJ25MA081438002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ148487V50Medicare PIN
PA113911V29Medicare PIN
PA113911YFEMedicare PIN