Provider Demographics
NPI:1346255650
Name:KIM, BUUP JUSTIN (MD)
Entity type:Individual
Prefix:DR
First Name:BUUP
Middle Name:JUSTIN
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:PO BOX 801143
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-1143
Mailing Address - Country:US
Mailing Address - Phone:573-331-5583
Mailing Address - Fax:573-331-5079
Practice Address - Street 1:3250 GORDONVILLE RD STE 358
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5095
Practice Address - Country:US
Practice Address - Phone:573-331-3155
Practice Address - Fax:573-331-5096
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022016384208G00000X
OH35061675K208G00000X
ND17672208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00210249OtherRAILROAD MEDICARE
OH0851056Medicaid
OH000000039032OtherANTHEM
OHP00210249OtherRAILROAD MEDICARE
OH0704685Medicare ID - Type Unspecified