Provider Demographics
NPI:1336123769
Name:KIM, ANNA SOOHYUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:SOOHYUNG
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7320 216TH ST SW
Mailing Address - Street 2:SUITE 220
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026
Mailing Address - Country:US
Mailing Address - Phone:425-637-3990
Mailing Address - Fax:425-673-3993
Practice Address - Street 1:7320 216TH ST SW
Practice Address - Street 2:SUITE 220
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026
Practice Address - Country:US
Practice Address - Phone:425-637-3990
Practice Address - Fax:425-673-3993
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00038208207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1117738Medicaid
WAAB36482Medicare PIN
H22125Medicare UPIN