Provider Demographics
NPI:1841293883
Name:J KIM RADIOLOGY ASSOCIATES PA
Entity type:Organization
Organization Name:J KIM RADIOLOGY ASSOCIATES PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONG
Authorized Official - Middle Name:K
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-724-1646
Mailing Address - Street 1:PO BOX 808
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21501-0808
Mailing Address - Country:US
Mailing Address - Phone:301-724-1646
Mailing Address - Fax:301-724-7429
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26847-9549
Practice Address - Country:US
Practice Address - Phone:304-257-1026
Practice Address - Fax:304-257-9776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DA4688OtherRAILROAD MEDICARE
MDJ247OtherMD BLUE SHIELD
WV0208455000Medicaid
WV001706092OtherMT ST BLUE SHIELD
MD215AOtherMD BLUE SHIELD
MD403914904Medicaid
MDJ247OtherMD BLUE SHIELD
WV9338813Medicare PIN