Provider Demographics
NPI:1356607121
Name:KIM, CHRISTOPHER J (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:J
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1615 HILL ROAD STE B
Mailing Address - Street 2:MARIN MEDICAL LABORATORIES
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-4338
Mailing Address - Country:US
Mailing Address - Phone:415-898-7649
Mailing Address - Fax:415-898-0870
Practice Address - Street 1:250 BON AIR RD
Practice Address - Street 2:
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-1702
Practice Address - Country:US
Practice Address - Phone:415-925-7174
Practice Address - Fax:415-461-7228
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2016-07-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA131506207ZP0102X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program