Basic Information
| Provider Information | |||||||||
| NPI: | 1255505178 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHUNG | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | LAUREN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. PH.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 208040 | ||||||||
| Address2: | DEPT OF THERAPEUTIC RADIOLOGY - YALE SCHOOL OF MEDICINE | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065208040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032002100 | ||||||||
| FaxNumber: | 2032002180 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 YORK ST | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065103220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032002100 | ||||||||
| FaxNumber: | 2032002180 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2008 | ||||||||
| LastUpdateDate: | 04/09/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 051767 | CT | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.