Active NPI
Chung K Kim, M.D.
- Orthopaedic Surgery Physician
- Valparaiso, IN
National Provider Identifier
1689618654
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Surgery Physician
- License
- 01030918A
- Practice address
- 2000 Roosevelt Rd
Suite 104
Valparaiso, IN 46383-2800 - Phone
- (219) 464-3063
- Fax
- (219) 462-6448
- NPI assigned
- Jun 16, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | 01030918A | IN | Primary |
Addresses
Primary practice location
2000 Roosevelt Rd
Suite 104
Valparaiso, IN 46383-2800
Mailing address
2000 Roosevelt Rd
Suite 104
Valparaiso, IN 46383-2800
Phone (219) 464-3063
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000084854 | Other | IN | BLUE CROSS PROVIDER NUMBE |
Other names 1
- John Chung Kiel Kim
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01030918A | IN | MD | Orthopaedic Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chung Kiel Kim | Orthopaedic Surgery | Past | Accepting new patients |
| The Methodist Hospitals, Inc | Orthopaedic Surgery | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Orthopaedic Surgery Physician
- Valparaiso, IN
- NPI 1780879114
-
- Gynecologic Oncology Physician
- Gary, IN
- NPI 1124283858
Orthopaedic Surgery
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150416000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1294012800000",
"number": "1689618654",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2000 ROOSEVELT RD",
"address_2": "SUITE 104",
"city": "VALPARAISO",
"state": "IN",
"postal_code": "463832800",
"telephone_number": "219-464-3063",
"fax_number": "219-462-6448"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2000 ROOSEVELT RD",
"address_2": "SUITE 104",
"city": "VALPARAISO",
"state": "IN",
"postal_code": "463832800",
"telephone_number": "219-464-3063",
"fax_number": "219-462-6448"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "CHUNG",
"middle_name": "K",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-16",
"last_updated": "2011-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "207X00000X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery",
"state": "IN",
"license": "01030918A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS PROVIDER NUMBE",
"identifier": "000000084854",
"state": "IN"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "JOHN",
"last_name": "KIM",
"middle_name": "CHUNG KIEL",
"credential": "M.D.",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Valparaiso, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.