Provider Demographics
NPI:1356441646
Name:KIM, STEVE HO-SUK (MD FACS)
Entity Type:Individual
Prefix:DR
First Name:STEVE
Middle Name:HO-SUK
Last Name:KIM
Suffix:
Gender:M
Credentials:MD FACS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1560 E MAPLE RD
Mailing Address - Street 2:SUITE 400-CREDENTIALING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1189
Mailing Address - Country:US
Mailing Address - Phone:800-527-6266
Mailing Address - Fax:313-576-8699
Practice Address - Street 1:4100 JOHN R ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2013
Practice Address - Country:US
Practice Address - Phone:800-527-6266
Practice Address - Fax:313-576-8699
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010976022086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301097602OtherMICHIGAN DEPARTMENT OF COMMUNITY HEALTH
NJ7653409Medicaid
NJBK6091538OtherDEA
MI4301097602OtherMICHIGAN DEPARTMENT OF COMMUNITY HEALTH
NJG78911Medicare UPIN
NJBK6091538OtherDEA