MEDICARE: J KIM RADIOLOGY ASSOCIATES PA

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	174400000X	Specialist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DA4688	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	J247	OTHER	MD	MD BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	001706092	OTHER	WV	MT ST BLUE SHIELD
5	215A	OTHER	MD	MD BLUE SHIELD
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841293883
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J KIM RADIOLOGY ASSOCIATES PA

Provider Business Mailing Address
First Line	:	PO BOX 808
Second Line	:
City	:	CUMBERLAND
State	:	MD
Zip	:	21501-0808
Country	:	US
Telephone Number	:	301-724-1646
Fax Number	:	301-724-7429

Provider Business Practice Location Address
First Line	:	1 HOSPITAL DR
Second Line	:
City	:	PETERSBURG
State	:	WV
Zip	:	26847-9549
Country	:	US
Telephone Number	:	304-257-1026
Fax Number	:	304-257-9776

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JONG K KIM
Credential	:	M.D.
Telephone Number	:	301-724-1646

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	11/25/2024

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