Provider Demographics
NPI:1770557506
Name:KIM, VLADLEN (MD)
Entity type:Individual
Prefix:DR
First Name:VLADLEN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5187 MAYFIELD RD
Mailing Address - Street 2:STE 102
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124
Mailing Address - Country:US
Mailing Address - Phone:440-449-1014
Mailing Address - Fax:440-449-8157
Practice Address - Street 1:5187 MAYFIELD RD
Practice Address - Street 2:STE 102
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124
Practice Address - Country:US
Practice Address - Phone:440-449-1014
Practice Address - Fax:440-449-8157
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073403207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1770557506OtherNPI
OH2059874Medicaid
G66648Medicare UPIN
G66648Medicare UPIN