Provider Demographics
NPI:1093795601
Name:KIM, HEJUNG (MD)
Entity Type:Individual
Prefix:
First Name:HEJUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HEJUNG
Other - Middle Name:
Other - Last Name:PRESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2001 LAUREL AVE
Mailing Address - Street 2:SUITE N304
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1810
Mailing Address - Country:US
Mailing Address - Phone:865-766-6870
Mailing Address - Fax:
Practice Address - Street 1:2001 LAUREL AVE
Practice Address - Street 2:SUITE N304
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1810
Practice Address - Country:US
Practice Address - Phone:865-766-6870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0341582085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3855500Medicaid
TNH18532Medicare UPIN
TN3855500Medicaid