Individual
DR. JONG H KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 E 80TH PL, STE 100E, MERRILLVILLE, IN 46410-5671
(219) 769-7536
(219) 736-1506
Mailing address
200 E 80TH PL, STE 100E, MERRILLVILLE, IN 46410-5671
(219) 769-7536
(219) 736-1506
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01036861A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000080494
ANTHEM
IN
01
—
00000053287J
ANTHEM
—
01
—
0000066817103
UNITED HEALTHCARE
—
05
—
100200870
—
IN
01
—
452016
AETNA
—
01
—
4520196
AETNA
—
01
—
AS65769900001
CONN GEN
—
Enumeration date
08/12/2005
Last updated
06/03/2011
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