Provider Demographics
NPI:1265657423
Name:KIM, CHARLES CS (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:CS
Last Name:KIM
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Gender:M
Credentials:MD
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Mailing Address - Street 1:455 LEWIS AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06451-2121
Mailing Address - Country:US
Mailing Address - Phone:203-237-8855
Mailing Address - Fax:203-237-8441
Practice Address - Street 1:455 LEWIS AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06451-2121
Practice Address - Country:US
Practice Address - Phone:203-237-8855
Practice Address - Fax:203-237-8441
Is Sole Proprietor?:No
Enumeration Date:2007-04-14
Last Update Date:2009-05-18
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Provider Licenses
StateLicense IDTaxonomies
CT015940174400000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD74055Medicare UPIN