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General NPI Number Information
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NPI Number | 1790963171
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Entity Type | Organization
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Legal Business Name | CHANGHEE KIM MD PHD PLC
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Dates
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Enumeration Date | 02/07/2008
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Last Update Date | 02/28/2008
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Provider Practice Location Address
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Address Line | 38815 DEQUINDRE RD SUITE 103
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City | TROY
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State | MI
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Zip | 48083-6810
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Country | US
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Telephone | 248-740-7771
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Fax |
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Provider Business Mailing Address
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Address Line | 38815 DEQUINDRE RD SUITE 103
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City | TROY
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State | MI
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Zip | 48083-6810
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Country | US
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Telephone | 248-740-7771
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHANGHEE KIM
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Credential | M.D.
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Telephone | 248-740-7771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301059643
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License Number State | MI
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