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1215918479 NPI number — CHANGHEE KIM MD

NPI Number: 1215918479
Health Care Provider/Practitioner: CHANGHEE KIM MD

Information about “1215918479” NPI (CHANGHEE KIM MD) exists in 1215918479 in HTML format HTML  |  1215918479 in plain Text format TXT  |  1215918479 in PDF (Portable Document Format) PDF  |  1215918479 in an XML format XML  formats.

NPI Number : 1215918479 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1215918479",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KIM",
    "FirstName": "CHANGHEE",
    "MiddleName": null,
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "HONG",
    "OtherFirstName": "CHANGHEE",
    "OtherMiddleName": "KIM",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "38815 DEQUINDRE RD",
    "SecondLineMailingAddress": "STE 103",
    "MailingAddressCityName": "TROY",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48083",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "248-740-7771",
    "MailingAddressFaxNumber": "248-740-7772",
    "FirstLinePracticeLocationAddress": "38815 DEQUINDRE RD",
    "SecondLinePracticeLocationAddress": "STE 103",
    "PracticeLocationAddressCityName": "TROY",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48083",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "248-740-7771",
    "PracticeLocationAddressFaxNumber": "248-740-7772",
    "EnumerationDate": "11/07/2005",
    "LastUpdateDate": "10/21/2014",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207Q00000X",
        "TaxonomyName": "Family Medicine Physician",
        "LicenseNumber": "4301059643",
        "LicenseNumberStateCode": "MI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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