Provider Demographics
NPI:1912006206
Name:KIM, CHRISTINA J (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:J
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8040 CLEARVISTA PARKWAY
Practice Address - Street 2:SUITE 290
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-5604
Practice Address - Country:US
Practice Address - Phone:317-621-7780
Practice Address - Fax:317-621-7783
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01063630A208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000526962OtherANTHEM
IN200870490Medicaid
IN000000609663OtherANTHEM
IN7264357OtherAETNA
INP01192259OtherRR MEDICARE PTAN
IN000000780867OtherANTHEM
IN000000526962OtherANTHEM
INP01192259OtherRR MEDICARE PTAN
IN200870490Medicaid
IN260640BMedicare PIN