Provider Demographics
NPI:1023094125
Name:KIM, CHI H (MD)
Entity type:Individual
Prefix:DR
First Name:CHI
Middle Name:H
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:100 SIMSBURY RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3793
Mailing Address - Country:US
Mailing Address - Phone:860-284-5111
Mailing Address - Fax:860-254-5114
Practice Address - Street 1:100 SIMSBURY RD
Practice Address - Street 2:SUITE 203
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3793
Practice Address - Country:US
Practice Address - Phone:860-284-5111
Practice Address - Fax:860-254-5114
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT037417207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1023094125OtherNPI
CT1023094125OtherNPI
CT110008884Medicare ID - Type Unspecified
G01320Medicare UPIN