Provider Demographics
NPI:1144241696
Name:KIM, MIN CHUNG (MD)
Entity Type:Individual
Prefix:
First Name:MIN
Middle Name:CHUNG
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2614 TAMIAMI TRAIL NORTH
Mailing Address - Street 2:225
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103
Mailing Address - Country:US
Mailing Address - Phone:239-262-3644
Mailing Address - Fax:239-262-3644
Practice Address - Street 1:8300 COLLIER BLVD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34114
Practice Address - Country:US
Practice Address - Phone:239-354-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94534207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274449000Medicaid
FL28800OtherBLUE CROSS OF FLORIDA
FLU6381VMedicare PIN
P00277886Medicare PIN
FL28800OtherBLUE CROSS OF FLORIDA
FLU6381XMedicare PIN
FLU6381ZMedicare PIN