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General NPI Number Information
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NPI Number | 1528620226
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Entity Type | Individual
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Provider Name | BYOUNGCHUL KIM MD
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Gender | Male
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Dates
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Enumeration Date | 07/02/2019
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 3200 MACCORKLE AVE SE
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City | CHARLESTON
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State | WV
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Zip | 25304-1227
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Country | US
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Telephone | 304-388-5432
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Fax |
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Provider Business Mailing Address
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Address Line | 3100 MACCORKLE AVE SE STE 406
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City | CHARLESTON
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State | WV
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Zip | 25304-1230
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Country | US
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Telephone | 304-388-5967
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301509578
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number | 34527
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License Number State | WV
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