Provider Demographics
NPI:1548210644
Name:MAN, KIM CHING (DO)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:CHING
Last Name:MAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:27901 WOODWARD AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-0919
Mailing Address - Country:US
Mailing Address - Phone:248-545-0070
Mailing Address - Fax:248-545-4850
Practice Address - Street 1:27901 WOODWARD AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-0919
Practice Address - Country:US
Practice Address - Phone:248-545-0070
Practice Address - Fax:248-545-4850
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101009642174400000X, 207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No174400000XOther Service ProvidersSpecialist
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3466966Medicaid
MIF42246Medicare UPIN
MI3466966Medicaid
MIOF36306Medicare ID - Type Unspecified