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Individual
SAMUEL CHAN KIM
Active
Individual
SAMUEL CHAN KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
01058979A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200476300A
—
IN
01
—
815500539
MEDICARE PTAN
IN
Enumeration date
07/27/2005
Last updated
08/11/2023
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