Provider Demographics
NPI:1972500791
Name:KIM, CHOONG (MD)
Entity Type:Individual
Prefix:
First Name:CHOONG
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 POWERHOUSE RD
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-1324
Mailing Address - Country:US
Mailing Address - Phone:516-626-6366
Mailing Address - Fax:
Practice Address - Street 1:900 CANTON AVE
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:BALTIMROE
Practice Address - State:MD
Practice Address - Zip Code:21229
Practice Address - Country:US
Practice Address - Phone:410-368-3045
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0020314174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist