Provider Demographics
NPI:1225070170
Name:KIM, SANG U (MD)
Entity Type:Individual
Prefix:
First Name:SANG
Middle Name:U
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:PO BOX 84088
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-8488
Mailing Address - Country:US
Mailing Address - Phone:425-454-5281
Mailing Address - Fax:425-990-5261
Practice Address - Street 1:1135 116TH AVE NE
Practice Address - Street 2:SUITE 560
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4623
Practice Address - Country:US
Practice Address - Phone:425-467-0150
Practice Address - Fax:425-467-0599
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00030024207RG0100X
COCDR.0002582207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB18882Medicare PIN