Provider Demographics
NPI:1023292950
Name:KIM, CHOONG R (MD)
Entity type:Individual
Prefix:
First Name:CHOONG
Middle Name:R
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1603 LARCH ST
Mailing Address - Street 2:UNIT 2819
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-0825
Mailing Address - Country:US
Mailing Address - Phone:360-636-4841
Mailing Address - Fax:360-636-6744
Practice Address - Street 1:1615 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2310
Practice Address - Country:US
Practice Address - Phone:360-636-4841
Practice Address - Fax:360-636-6744
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000306052085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR061288Medicaid
WA1082841Medicaid
WAE42043Medicare UPIN