Basic Information
Provider Information
NPI: 1811155922
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KIM
FirstName: CHRISTINE
MiddleName: H.
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 783311
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191783311
CountryCode: US
TelephoneNumber: 4848844500
FaxNumber: 4848840699
Practice Location
Address1: 1240 S CEDAR CREST BLVD STE 401
Address2:  
City: ALLENTOWN
State: PA
PostalCode: 18103
CountryCode: US
TelephoneNumber: 6104023650
FaxNumber: 6104023673
Other Information
ProviderEnumerationDate: 05/26/2008
LastUpdateDate: 12/16/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/16/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000XMD448986PAN Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 
207VX0201XMD448986PAY Allopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology

No ID Information.


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