Provider Demographics
NPI:1255505178
Name:JOHUNG, KIMBERLY LAUREN (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:LAUREN
Last Name:JOHUNG
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 208040
Mailing Address - Street 2:DEPT OF THERAPEUTIC RADIOLOGY - YALE SCHOOL OF MEDICINE
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06520-8040
Mailing Address - Country:US
Mailing Address - Phone:203-200-2100
Mailing Address - Fax:203-200-2180
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-200-2100
Practice Address - Fax:203-200-2180
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0517672085R0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program