Provider Demographics
NPI:1437132255
Name:KIM, CHEUNG K (MD)
Entity Type:Individual
Prefix:
First Name:CHEUNG
Middle Name:K
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:PO BOX 938
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76540-0938
Mailing Address - Country:US
Mailing Address - Phone:254-634-6999
Mailing Address - Fax:254-200-4090
Practice Address - Street 1:3106 S W S YOUNG DR
Practice Address - Street 2:STE B-203
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-2000
Practice Address - Country:US
Practice Address - Phone:254-554-8668
Practice Address - Fax:254-200-4090
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-25
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7542207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00R75FOtherBLUE CROSS BLUE SHIELD
TX111615401OtherSUPERIOR CHIPS
TX111615401Medicaid
TX111615402Medicaid
TX111615401OtherSUPERIOR CHIPS
TX111615401Medicaid