Provider Demographics
NPI:1003076696
Name:KIM, UN CHONG (NP)
Entity Type:Individual
Prefix:
First Name:UN
Middle Name:CHONG
Last Name:KIM
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:850 ENTERPRISE PKWY
Practice Address - Street 2:SUITE 2000
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-6251
Practice Address - Country:US
Practice Address - Phone:757-838-5055
Practice Address - Fax:757-827-0129
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2014-01-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0024169791363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP01090295Medicare PIN
VA1003076696Medicaid
VAVV6074AMedicare PIN