Individual ProviderDavid D KimAnesthesiologyAllopathic & Osteopathic PhysiciansPractice Address1201 Nott St, Suite 106, Schenectady, NY 12308-2589(518) 374-3123PECOS EnrollmentThis provider is enrolled in PECOS as DAVID KIM.Based on the most recent information from CMS, provider David D Kim is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1295727873Provider TypeIndividualFull NameKim, David DTitleDr.CredentialM.D.GenderMaleSole ProprietorNoEnumeration Date8/18/2005Last Updated1/26/2011Contact InformationPractice LocationPractice Address1201 Nott St, Suite 106, Schenectady, NY 12308-2589Phone(518) 374-3123Fax(518) 374-9711Mailing LocationMailing Address1201 Nott St, Suite 106, Schenectady, NY 12308-2589Phone(518) 374-3123Fax(518) 374-9711Provider TaxonomiesCodeDescriptionLicenseCode207L00000XPrimaryDescriptionAnesthesiologyAllopathic & Osteopathic PhysiciansLicense177315-1New YorkProvider IdentifiersIDDescriptionIssuerID040426006649DescriptionOtherIssuerFIDELISID110160500DescriptionOtherIssuerUS DEPT OF LABORID000000085413DescriptionOtherIssuerGHI HMOID10001061DescriptionOtherIssuerCDPHPID000405016001DescriptionOtherIssuerBLUE SHIELD NENYID177315-1DescriptionOtherIssuerTRICARE NORTH REGIONID9715959DescriptionOtherIssuerGHIID000405016002DescriptionOtherIssuerBLUE SHIELD NENYID01273418DescriptionMedicaidIssuerUnlistedNew YorkID33588KDescriptionOtherIssuerFIDELIS MEDICAREIDE42294DescriptionOtherIssuerAMERICAN PROGRESSIVE TODAID05155DescriptionOtherIssuerMVPIDCAN1773159DescriptionOtherIssuerNO FAULTIDCAN1773159DescriptionOtherIssuerWORKERS COMPIDDK094V4110DescriptionOtherIssuerEMPIRE BLUE CROSSIDDK094V4120DescriptionOtherIssuerEMPIRE BLUE CROSS