1801802343 NPI number — CHUNG HOON KIM MD

Table of content: CHUNG HOON KIM MD (NPI 1801802343)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801802343 NPI number — CHUNG HOON KIM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIM
Provider First Name:
CHUNG
Provider Middle Name:
HOON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801802343
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 OFFICE PKWY
Provider Second Line Business Mailing Address:
SUITE B TOBEY VILLAGE OFFICE PARK
Provider Business Mailing Address City Name:
PITTSFORD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14534-1700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-381-1860
Provider Business Mailing Address Fax Number:
585-381-2269

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 OFFICE PKWY
Provider Second Line Business Practice Location Address:
SUITE B TOBEY VILLAGE OFFICE PARK
Provider Business Practice Location Address City Name:
PITTSFORD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14534-1700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-381-1860
Provider Business Practice Location Address Fax Number:
585-381-2269
Provider Enumeration Date:
08/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  188548 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 101412BT . This is a "PREFERRED CARE (ALL)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7068140 . This is a "AETNA ALL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2308 . This is a "BLUE CROSS BLUE SHIELD AL" identifier . This identifiers is of the category "OTHER".
  • Identifier: MDF978 . This is a "PREFERRED CARE ALL BILLIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01340963 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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