=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952409922
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHOONG R. KIM, M.D.,P.S.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2006
-----------------------------------------------------
Last Update Date | 11/21/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1615 DELAWARE ST
-----------------------------------------------------
City | LONGVIEW
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98632-2310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-636-4841
-----------------------------------------------------
Fax | 360-636-6744
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2819
-----------------------------------------------------
City | LONGVIEW
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98632-8796
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-636-4841
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | CHOONG R. KIM
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 360-636-4841
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0001X
-----------------------------------------------------
Taxonomy Name | Radiation Oncology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------