Individual
CHUNG K KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2000 ROOSEVELT RD, SUITE 104, VALPARAISO, IN 46383-2800
(219) 464-3063
(219) 462-6448
Mailing address
2000 ROOSEVELT RD, SUITE 104, VALPARAISO, IN 46383-2800
(219) 464-3063
(219) 462-6448
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
01030918A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000084854
BLUE CROSS PROVIDER NUMBE
IN
Enumeration date
06/16/2006
Last updated
01/03/2011
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