Provider Demographics
NPI:1902809304
Name:KIM, CADENCE A (MD)
Entity Type:Individual
Prefix:
First Name:CADENCE
Middle Name:A
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 8500-6335
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-6335
Mailing Address - Country:US
Mailing Address - Phone:215-745-1612
Mailing Address - Fax:215-745-8319
Practice Address - Street 1:1342 COTTMAN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-3729
Practice Address - Country:US
Practice Address - Phone:215-745-1612
Practice Address - Fax:215-745-8319
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD060440L208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA890505OtherHIGHMARK BLUE SHIELD
PA0120797000OtherKEYSTONE IBC
PA8317350OtherAETNA
PAP01043225OtherRAILROAD MEDICARE
PA30106258OtherKEYSTONE MERCY
PA0016316400002Medicaid
PA0120797000OtherKEYSTONE IBC
PA8317350OtherAETNA
PAP01043225OtherRAILROAD MEDICARE