Provider Demographics
NPI:1740379981
Name:KIM, JONG W (MD)
Entity Type:Individual
Prefix:DR
First Name:JONG
Middle Name:W
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8100 TWISTED HICKORY RD
Mailing Address - Street 2:
Mailing Address - City:BLADENBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28320-7010
Mailing Address - Country:US
Mailing Address - Phone:910-876-7301
Mailing Address - Fax:910-648-5650
Practice Address - Street 1:8100 TWISTED HICKORY RD
Practice Address - Street 2:
Practice Address - City:BLADENBORO
Practice Address - State:NC
Practice Address - Zip Code:28320-7010
Practice Address - Country:US
Practice Address - Phone:910-862-5500
Practice Address - Fax:910-862-2107
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2017-09-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC200101455207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCG78735Medicare UPIN