Provider Demographics
NPI:1073520359
Name:KIM, GREGORY YUNG SUK (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:YUNG SUK
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 COLISEUM DR
Mailing Address - Street 2:STE 200
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-5963
Mailing Address - Country:US
Mailing Address - Phone:757-736-7280
Mailing Address - Fax:757-224-3541
Practice Address - Street 1:3000 COLISEUM DR
Practice Address - Street 2:STE 200
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-5963
Practice Address - Country:US
Practice Address - Phone:757-736-7280
Practice Address - Fax:757-224-3541
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2015-02368208600000X
TXM1832208600000X
VA0101057985208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1776049Medicaid
TX8D9346Medicare ID - Type Unspecified
TX1776049Medicaid