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General NPI Number Information
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NPI Number | 1619296936
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Entity Type | Organization
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Legal Business Name | DR CASEY KIM PLLC
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Dates
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Enumeration Date | 05/26/2010
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Last Update Date | 06/02/2011
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Provider Practice Location Address
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Address Line | 7902 EAGLE MERE RD
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City | CHATTANOOGA
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State | TN
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Zip | 37421-7315
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Country | US
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Telephone | 423-619-4894
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Fax |
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Provider Business Mailing Address
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Address Line | 7902 EAGLE MERE RD
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City | CHATTANOOGA
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State | TN
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Zip | 37421-7315
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. KYONGCHOL KIM
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Credential | MD
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Telephone | 423-619-4894
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 43029
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License Number State | TN
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