Provider Demographics
NPI:1780619742
Name:KIM, CHRISTOPHER KONKYO (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:KONKYO
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 COURT ST STE 100
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1652
Mailing Address - Country:US
Mailing Address - Phone:304-347-6120
Mailing Address - Fax:304-347-6142
Practice Address - Street 1:400 COURT ST STE 100
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1652
Practice Address - Country:US
Practice Address - Phone:304-347-6120
Practice Address - Fax:304-347-6142
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057983207LP2900X, 208VP0014X
WV19743207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001722099OtherMSBCBS
WV2154423OtherUHC-PAIN
WV151628500OtherFEDERAL WORKERS COMP
WV050068304OtherRR MEDICARE
WV0011128000Medicaid
OH2121322Medicaid
WV3154530OtherUHC-ANESTHESIA
WVCI5175OtherRR MEDICARE
WV3154530OtherUHC-ANESTHESIA
OH2121322Medicaid
WVG70775Medicare UPIN
WV5544650001Medicare NSC
WV050068304OtherRR MEDICARE
WV9296571Medicare PIN
WV110912OtherCARELINK
WVG70775Medicare UPIN
WV3120417OtherMAMSI
WV050068304OtherRR MEDICARE