Provider Demographics
NPI:1023386877
Name:KIM, SUN KWON (MD, PHD)
Entity Type:Individual
Prefix:
First Name:SUN KWON
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1560 E MAPLE RD
Mailing Address - Street 2:SUITE 400-CREDENTIALING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1138
Mailing Address - Country:US
Mailing Address - Phone:313-745-4525
Mailing Address - Fax:313-745-4399
Practice Address - Street 1:4201 SAINT ANTOINE ST
Practice Address - Street 2:STE 4C
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2153
Practice Address - Country:US
Practice Address - Phone:313-745-4525
Practice Address - Fax:313-745-4399
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301091570207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology