Provider Demographics
NPI:1033119417
Name:KIM, SANG HOON (MD)
Entity Type:Individual
Prefix:DR
First Name:SANG
Middle Name:HOON
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9002 N MERIDIAN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5381
Mailing Address - Country:US
Mailing Address - Phone:317-573-4410
Mailing Address - Fax:317-573-4412
Practice Address - Street 1:9002 N MERIDIAN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5381
Practice Address - Country:US
Practice Address - Phone:317-573-4410
Practice Address - Fax:317-573-4412
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2010-05-24
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Provider Licenses
StateLicense IDTaxonomies
IN01040301207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100196490CMedicaid
IN100196490CMedicaid
IN895620AMedicare PIN