Provider Demographics
NPI:1134323561
Name:S AND S KIM GROUP PC
Entity Type:Organization
Organization Name:S AND S KIM GROUP PC
Other - Org Name:BRIGHTON FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUNGWOOK
Authorized Official - Middle Name:S
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-566-5445
Mailing Address - Street 1:1450 W HORIZON RIDGE PKWY STE B305 # 570
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-4480
Mailing Address - Country:US
Mailing Address - Phone:702-566-5445
Mailing Address - Fax:702-448-7221
Practice Address - Street 1:1720 W HORIZON RIDGE PKWY STE 140
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-4896
Practice Address - Country:US
Practice Address - Phone:702-566-5445
Practice Address - Fax:702-566-5035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100512773Medicaid
NVV104499Medicare PIN