Provider Demographics
NPI:1245398874
Name:KIM, CHOON KYU (MD)
Entity Type:Individual
Prefix:
First Name:CHOON
Middle Name:KYU
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 1:216 A WASHINGTON HEIGHTS MEDICAL CENTER
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157
Mailing Address - Country:US
Mailing Address - Phone:410-848-1212
Mailing Address - Fax:410-848-7944
Practice Address - Street 1:216 A WASHINGTON HEIGHTS MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157
Practice Address - Country:US
Practice Address - Phone:410-848-1212
Practice Address - Fax:410-848-7944
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0040235207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC64697Medicare UPIN
MD043M818EMedicare ID - Type Unspecified