Provider Demographics
NPI:1942295258
Name:KIM, BYUNG J (MD)
Entity Type:Individual
Prefix:
First Name:BYUNG
Middle Name:J
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1849
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04241-1849
Mailing Address - Country:US
Mailing Address - Phone:207-784-2554
Mailing Address - Fax:207-777-5363
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-9641
Practice Address - Country:US
Practice Address - Phone:207-778-6031
Practice Address - Fax:207-779-2433
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0166882085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME022291OtherBLUE CROSS/BLUE SHIELD
P00073383OtherRR MEDICARE
010538626OtherCHAMPUS
ME312270099Medicaid
ME022291OtherBLUE CROSS/BLUE SHIELD
010538626OtherCHAMPUS