Provider Demographics
NPI:1891736484
Name:KIM, CHRISTOPHER KISOK (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:KISOK
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1115 BOULDERS PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4067
Mailing Address - Country:US
Mailing Address - Phone:804-560-5595
Mailing Address - Fax:804-560-9029
Practice Address - Street 1:1115 BOULDERS PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23225-4067
Practice Address - Country:US
Practice Address - Phone:804-320-1339
Practice Address - Fax:804-330-5829
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101236255207X00000X, 207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA540885859OtherCOMPMANAGEMENT
VA540885859OtherFIRST HEALTH/CCN
VA540885859OtherCIGNA
VA902428OtherUNITED HEALTHCARE
VA242742OtherSOUTHERN HEALTH
VA540885859OtherFOCUS
VA137872OtherANTHEM HEALTHKEEPERS
VA49648OtherSH CARENET
VAP00247549OtherRAILROAD MEDICARE
VA1891736484Medicaid
VA2138280OtherUNITED HEALTHCARE MAMSI
VA78569OtherOPTIMA HEALTH
VA7010538OtherAETNA HMO
VA010066298Medicaid
VA540885859OtherVIRGINIA HEALTH NETWORK
VA540885859OtherC&O EMPLOYEES HEALTHCARE
VA540885859OtherCORVEL
VA0472640006Medicare NSC
VA7010538OtherAETNA HMO
VA242742OtherSOUTHERN HEALTH