Provider Demographics
NPI:1285232165
Name:KIM, SEUNG (NP)
Entity Type:Individual
Prefix:
First Name:SEUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:NP
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:14510 W SHUMWAY DR STE 201
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-5817
Mailing Address - Country:US
Mailing Address - Phone:623-444-6463
Mailing Address - Fax:623-213-8145
Practice Address - Street 1:14510 W SHUMWAY DR STE 201
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-5817
Practice Address - Country:US
Practice Address - Phone:623-444-6463
Practice Address - Fax:623-213-8145
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2022-12-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ248058363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily