Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 0101030894 | VA |
NPI | 1053303180 |
---|---|
Provider Name | Myung Woong Kim |
First Address | Hampton, VA 23666-6080 |
Second Address | Hampton, VA 23666-6080 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B08464 | (02) |