Provider Demographics
NPI:1750459350
Name:KIM, CHONG DUK (MD)
Entity Type:Individual
Prefix:DR
First Name:CHONG
Middle Name:DUK
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7300 OLD YORK RD
Mailing Address - Street 2:STE 203
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-3037
Mailing Address - Country:US
Mailing Address - Phone:215-635-9000
Mailing Address - Fax:215-782-2232
Practice Address - Street 1:7300 OLD YORK RD
Practice Address - Street 2:STE 203
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-3037
Practice Address - Country:US
Practice Address - Phone:215-635-9000
Practice Address - Fax:215-782-2232
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2012-10-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD030721E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1750459350OtherBRAVO
PA0850038001OtherKEYSTONE HEALTH PLAN EAST
PA085936OtherAETNA
PA1019107OtherKEYSTONE MERCY
PAK808570OtherAMERIHEALTH
PA0850038001OtherBLUE CROSS BLUE SHIELD
PA37121OtherHEALTH PARTNERS
PAKI057254Medicare ID - Type Unspecified
PAB96891Medicare UPIN