Provider Demographics
NPI:1306162060
Name:KIM, CHRISTINE HAEJUN (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:HAEJUN
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 1:15043 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-3615
Mailing Address - Country:US
Mailing Address - Phone:917-434-6625
Mailing Address - Fax:
Practice Address - Street 1:15043 23RD AVE
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-3615
Practice Address - Country:US
Practice Address - Phone:917-434-6625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2564091207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology