MEDICARE: DR. CHUNGSOO KIM PHARMD, PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1744R1102X	Research Study Specialist

General Provider Information

NPI Number	:	1356202394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHUNGSOO KIM PHARMD, PHD

Provider Business Mailing Address
First Line	:	32 HIGH ST APT 203
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06510-2319
Country	:	US
Telephone Number	:	203-390-8716
Fax Number	:

Provider Business Practice Location Address
First Line	:	195 CHURCH ST
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06510-2009
Country	:	US
Telephone Number	:	203-390-8716
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2025
Last Update Date	:	11/19/2025

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