Provider Demographics
NPI:1912006206
Name:KIM, CHRISTINA J (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:J
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13914 SOUTHEASTERN PKWY STE 203A
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-7125
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13914 SOUTHEASTERN PKWY STE 203A
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-7125
Practice Address - Country:US
Practice Address - Phone:317-582-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01063630A2086X0206X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000609663OtherANTHEM
IN000000526962OtherANTHEM
IN7264357OtherAETNA
IN000000780867OtherANTHEM
INP01192259OtherRR MEDICARE PTAN
IN200870490Medicaid
IN000000526962OtherANTHEM
INP01192259OtherRR MEDICARE PTAN
IN200870490Medicaid
IN260640BMedicare PIN