Provider Demographics
NPI:1649449653
Name:KIM, CHRISTOPHER S (DO)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:S
Last Name:KIM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 VENICE DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2063
Mailing Address - Country:US
Mailing Address - Phone:808-856-5983
Mailing Address - Fax:855-242-1501
Practice Address - Street 1:902 VENICE DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2063
Practice Address - Country:US
Practice Address - Phone:808-856-5983
Practice Address - Fax:855-242-1501
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-23
Last Update Date:2021-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4759207R00000X
HIDOS1247207R00000X
GUDO-0088207R00000X, 208M00000X
MDH0068814207R00000X, 208M00000X
DEC2-0010345208M00000X
VT032.0130207208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ128488Medicare PIN