Individual
KI-BONG UM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
501 N MAIN ST, ROBERSONVILLE, NC 27871-9567
(252) 795-4192
(252) 795-4739
Mailing address
501 N MAIN ST, PO BOX 625, ROBERSONVILLE, NC 27871-9567
(252) 795-4192
(252) 795-4739
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
25751
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20503
CIGNA
NC
01
—
84530
BC
NC
05
—
8984530
—
NC
Enumeration date
05/26/2006
Last updated
11/30/2009
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