Provider Demographics
NPI:1912067901
Name:KIM, HYUNGCHUL CHARLES (MD)
Entity type:Individual
Prefix:
First Name:HYUNGCHUL
Middle Name:CHARLES
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:H
Other - Middle Name:CHARLES
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7505 OSLER DRIVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204
Mailing Address - Country:US
Mailing Address - Phone:410-583-1313
Mailing Address - Fax:410-296-4073
Practice Address - Street 1:7505 OSLER DRIVE
Practice Address - Street 2:SUITE 201
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204
Practice Address - Country:US
Practice Address - Phone:410-583-1313
Practice Address - Fax:410-296-4073
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0022505208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD266601400Medicaid
MD4956HCMedicare ID - Type Unspecified
MD266601400Medicaid