Provider Demographics
NPI:1528034485
Name:KIM, CHONG U (MD)
Entity type:Individual
Prefix:
First Name:CHONG
Middle Name:U
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 66596
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98166-0596
Mailing Address - Country:US
Mailing Address - Phone:424-328-0203
Mailing Address - Fax:424-328-0204
Practice Address - Street 1:23560 MADISON ST STE 204
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4710
Practice Address - Country:US
Practice Address - Phone:424-328-0203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54806207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine