Provider Demographics
NPI:1144210725
Name:KIM, SHARON STRONG (MD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:STRONG
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:MARIE
Other - Last Name:STRONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:393 E. WALNUT ST.
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91188
Mailing Address - Country:US
Mailing Address - Phone:626-405-2681
Mailing Address - Fax:858-636-4319
Practice Address - Street 1:3860 CALLE FORTUNADA
Practice Address - Street 2:STE 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4800
Practice Address - Country:US
Practice Address - Phone:858-636-4300
Practice Address - Fax:858-636-4319
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC52524208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG26745Medicare UPIN