Provider Demographics
NPI:1053303180
Name:KIM, MYUNG WOONG (MD)
Entity Type:Individual
Prefix:
First Name:MYUNG
Middle Name:WOONG
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 1:501 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-6080
Mailing Address - Country:US
Mailing Address - Phone:757-826-7785
Mailing Address - Fax:757-826-9028
Practice Address - Street 1:501 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-6080
Practice Address - Country:US
Practice Address - Phone:757-826-7785
Practice Address - Fax:757-826-9028
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101030894207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B08464Medicare UPIN