Provider Demographics
NPI:1538188347
Name:KIM, CHONG SANG (MD)
Entity type:Individual
Prefix:
First Name:CHONG
Middle Name:SANG
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NONE
Other - Middle Name:
Other - Last Name:NONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3010 W ORANGE AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-3171
Mailing Address - Country:US
Mailing Address - Phone:714-236-2825
Mailing Address - Fax:714-236-2836
Practice Address - Street 1:3010 W ORANGE AVE STE 203
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3171
Practice Address - Country:US
Practice Address - Phone:714-236-2825
Practice Address - Fax:714-236-2836
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG140422084N0400X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Not Answered208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G140420Medicaid
CAA89208Medicare UPIN
CA00G140420Medicaid