Healthcare Provider Details

I. General information

NPI: 1295750701
Provider Name (Legal Business Name): CHONG M. KIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 05/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 N MAIN ST STE 104
CAPE MAY COURT HOUSE NJ
08210
US

IV. Provider business mailing address

PO BOX 593
CAPE MAY COURT HOUSE NJ
08210-0593
US

V. Phone/Fax

Practice location:
  • Phone: 609-463-1488
  • Fax: 609-463-4881
Mailing address:
  • Phone: 609-463-2755
  • Fax: 609-463-2757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number207433
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD426470
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number25MA09395500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: