Provider Demographics
NPI:1316966062
Name:KIM, CHI-HYUN (MD)
Entity type:Individual
Prefix:
First Name:CHI-HYUN
Middle Name:
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 1:2150 PENNSYLVANIA AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-3201
Mailing Address - Country:US
Mailing Address - Phone:202-741-2222
Mailing Address - Fax:202-741-2185
Practice Address - Street 1:2150 PENNSYLVANIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-3201
Practice Address - Country:US
Practice Address - Phone:202-741-2222
Practice Address - Fax:202-741-2185
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00040631207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8311094Medicaid
WAUS7255507OtherAETNA/USHC SPECIALIST
WA1749KIOtherBLUE SHIELD
WA0039581OtherLABOR & INDUSTRY
WA0039581OtherLABOR & INDUSTRY
WA8311094Medicaid
WAG8879783Medicare PIN