Provider Demographics
NPI:1528134657
Name:CHUNG H. KIM MD, PC
Entity type:Organization
Organization Name:CHUNG H. KIM MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHUNG
Authorized Official - Middle Name:HOON
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-381-1860
Mailing Address - Street 1:130 OFFICE PARK WAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-1700
Mailing Address - Country:US
Mailing Address - Phone:585-381-1860
Mailing Address - Fax:585-381-2269
Practice Address - Street 1:130 OFFICE PARK WAY
Practice Address - Street 2:SUITE B
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-1700
Practice Address - Country:US
Practice Address - Phone:585-381-1860
Practice Address - Fax:585-381-2269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01340963Medicaid
NY2308OtherBLUE CROSS BLUE SHIELD
NY000915215002OtherHEALTH NOW
NY101412BTOtherPREFERRED CARE
NY7068140OtherAETNA
NY01340963Medicaid
NY000915215002OtherHEALTH NOW
NY2308OtherBLUE CROSS BLUE SHIELD
NY=========OtherEMPIRE BLUE CROSS BLUE SH
NY=========OtherEMPIRE PLAN
NYD80904Medicare UPIN
NY7068140OtherAETNA