MYUNG-SUP KIM MD PA (NPI# 1457311656) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457311656 |
| Entity Type | Organization |
| Organization Name | MYUNG-SUP KIM MD PA |
| Practice Address |
Rt 55 West Petersburg WV 26847 |
| Mailing Address |
Po Box 240 Cumberland MD 21501-0240 |
| Practice Telephone | 3042571026 |
| Mailing Telephone | 3017241646 |
| Mailing Fax Number | 3017247429 |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2010-08-16 |
| Authorized Official Name | DR. MYUNG-SUP KIM (PRESIDENT) |
| Authorized Official Telephone | 3017241646 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MAMSI | 1120362 | 01 | |
| MD | FEDERAL BS | S366 | 01 |
| MD | BLUE SHIELD | KCD4 | 01 |
| MD | 991702100 | 05 | |
| BLACK LUNG | 02059300 | 01 | |
| WV | 3810011406 | 05 | |
| WV | BLUE SHIELD | 001708869 | 01 |
| Street Address |
RT 55 WEST |
| City | PETERSBURG |
| State | WV |
| Zip Code | 26847 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720688419 | Kimberly Dawn Runion | Technician | 791 Cave Mtn Rd, Petersburg, WV 26847 | 2020-10-30 |
| 1417568445 | Sandra Shook | Technician | 145 Army Lane, Petersburg, WV 26847 | 2020-08-13 |
| 1023590874 | Milas Robertson | Registered Nurse | 117 Hospital Drive, Petersbirg, WV 26847 | 2018-08-29 |
| 1043723851 | Cathy Lynn Arbogast | Technician | 6114 Rig Road, Rig, WV 26847 | 2017-11-15 |
| 1497028500 | Fort Ashby Business Associates, Inc. | Hearing Aid Equipment | 141 Water Street, Moorefield, WV 26847 | 2012-02-21 |
| 1770856882 | Fort Ashby Business Associates, Inc | Durable Medical Equipment & Medical Supplies | 1045 North Fork Highway, Petersburg, WV 26847 | 2012-02-21 |
| 1518278118 | Amanda Marie Borror | Obstetrics & Gynecology | 65 Hospital Dr Ste 104, Petersburg, WV 26847 | 2010-06-29 |
| 1700055365 | Grant County Board of Education | Local Education Agency (LEA) | 204 Jefferson Avenue, Grant County Board of Education, Petersburg, WV 26847 | 2008-02-27 |
| 1679741664 | Andrea D Brogan | Speech-Language Pathologist | Grant County Board of Education, 204 Jefferson Avenue, Petersburg, WV 26847 | 2008-02-13 |
| 1538347943 | Larry C. Rogers | Family Medicine | Memorial Dr, Petersburg, WV 26847 | 2008-02-07 |
| Find all providers in zip 26847 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083754790 | Professional Health Care, Inc. | Specialist | 849 S Sycamore St, Suite E, Petersburg, VA 23803-5801 | 2007-02-08 |
| 1023086915 | Frank F Shieh | Specialist | 603 S Sycamore St, Petersburg, VA 23803 | 2006-03-08 |
| 1972983393 | Grant Memorial Hospital | Specialist | 65 Hospital Dr Ste 103, Petersburg, WV 26847-9549 | 2015-06-01 |
| 1316150006 | Southside Ob-gyn, Inc. | Specialist | 600 S Sycamore St, Petersburg, VA 23803-5815 | 2007-05-08 |
| 1497872980 | Team Rehab, Inc | Specialist | 95 Medical Park Blvd, Petersburg, VA 23805-9280 | 2007-03-22 |
| 1447365945 | Central Virginia Oncology, Inc. | Specialist | 700 S Sycamore St, Ste 10, Petersburg, VA 23803 | 2006-08-21 |
| 1447205554 | Russell Johnson | Specialist | 601 Old Wagner Rd, Suite 101, Petersburg, VA 23805-9313 | 2006-05-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578171013 | Nicole Maynor | Specialist | 1 Avenue C Ste 110, Madison, WV 25130-1100 | 2020-07-21 |
| 1992262257 | Marnie Rustemeyer | Specialist | 1306 Kanawha Blvd E Ste 1001306, Charleston, WV 25301-3000 | 2019-02-22 |
| 1528599800 | Angela Dawn Harold | Specialist | 2241 Ritter Dr, Daniels, WV 25832-2241 | 2017-03-27 |
| 1770023244 | Katelynn Decker | Specialist | 428 W Martin St, Martinsburg, WV 25401-2747 | 2017-03-03 |
| 1699227751 | Sara Elizabeth Hill | Specialist | Sr 3 and 12, Talcott, WV 24981 | 2016-10-25 |
| 1558818294 | Keri Browning | Specialist | 294 Shawnee Cir, Monaville, WV 25601-9631 | 2016-09-09 |
| 1356715429 | Body Kneads LLC | Specialist | 19 Main Ave, Logan, WV 25601-3332 | 2015-11-30 |
| 1982071866 | Archer Massage and Wellness | Specialist | 6 Harman Ctr, Grafton, WV 26354-1559 | 2015-08-27 |
| 1003299652 | Wmc Physician Practices LLC | Specialist | 651 Colliers Way Ste 300, Weirton, WV 26062-5058 | 2015-07-01 |
| 1710360367 | Wmc Physician Practices LLC | Specialist | 651 Colliers Way Ste 309, Weirton, WV 26062-5055 | 2015-07-01 |
| Find all providers with the same taxonomy | ||||
| City | PETERSBURG |
| Zip Code | 26847 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.