Provider Demographics
NPI:1528034485
Name:KIM, CHONG UN (MD)
Entity Type:Individual
Prefix:
First Name:CHONG
Middle Name:UN
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:23560 MADISON ST
Mailing Address - Street 2:STE 204
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4710
Mailing Address - Country:US
Mailing Address - Phone:310-373-1253
Mailing Address - Fax:310-683-6321
Practice Address - Street 1:23430 HAWTHORNE BLVD BLDG 3
Practice Address - Street 2:SUITE 325
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4720
Practice Address - Country:US
Practice Address - Phone:310-705-8323
Practice Address - Fax:310-683-6321
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2020-02-28
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Provider Licenses
StateLicense IDTaxonomies
CAA54806207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine