Organization
J KIM RADIOLOGY ASSOCIATES PA
Active
Other names
PRO RADIOLOGY
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONG K KIM M.D. (PRESIDENT)
(301) 724-1646
Entity
Organization
Contact information
Practice address
1 HOSPITAL DR, PETERSBURG, WV 26847-9549
(304) 257-1026
(304) 257-9776
Mailing address
PO BOX 808, CUMBERLAND, MD 21501-0808
(301) 724-1646
(301) 724-7429
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001706092
MT ST BLUE SHIELD
WV
05
—
0208455000
—
WV
01
—
215A
MD BLUE SHIELD
MD
05
—
403914904
—
MD
01
—
DA4688
RAILROAD MEDICARE
—
01
—
J247
MD BLUE SHIELD
MD
Enumeration date
05/23/2005
Last updated
11/25/2024
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