Provider Demographics
NPI:1801802343
Name:KIM, CHUNG HOON (MD)
Entity type:Individual
Prefix:
First Name:CHUNG
Middle Name:HOON
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 1:130 OFFICE PKWY
Mailing Address - Street 2:SUITE B TOBEY VILLAGE OFFICE PARK
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-1700
Mailing Address - Country:US
Mailing Address - Phone:585-381-1860
Mailing Address - Fax:585-381-2269
Practice Address - Street 1:130 OFFICE PKWY
Practice Address - Street 2:SUITE B TOBEY VILLAGE OFFICE PARK
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-1700
Practice Address - Country:US
Practice Address - Phone:585-381-1860
Practice Address - Fax:585-381-2269
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188548207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
101412BTOtherPREFERRED CARE (ALL)
7068140OtherAETNA ALL
2308OtherBLUE CROSS BLUE SHIELD AL
MDF978OtherPREFERRED CARE ALL BILLIN
NY01340963Medicaid
NY01340963Medicaid
CC6501Medicare ID - Type Unspecified