Provider Demographics
NPI:1114989555
Name:KIM, SUNNY S (MD)
Entity Type:Individual
Prefix:DR
First Name:SUNNY
Middle Name:S
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 1:6600 STATE HIGHWAY 29 S
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-6196
Mailing Address - Country:US
Mailing Address - Phone:320-763-8888
Mailing Address - Fax:320-763-8898
Practice Address - Street 1:1601 HIGHWAY 13 E STE 211
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-5105
Practice Address - Country:US
Practice Address - Phone:320-763-8888
Practice Address - Fax:952-405-9760
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN31927207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN31927OtherSTATE LICENSE #
MN1748051Medicaid
MN31927OtherSTATE LICENSE #
MN200001715Medicare ID - Type UnspecifiedMEDICARE #