Provider Demographics
NPI:1366452245
Name:KIM, SUNG K (MD)
Entity Type:Individual
Prefix:
First Name:SUNG
Middle Name:K
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10800 MAGNOLIA AVE
Mailing Address - Street 2:DEPARTMENT OF GENERAL SURGERY
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-3043
Mailing Address - Country:US
Mailing Address - Phone:951-353-3606
Mailing Address - Fax:951-353-5406
Practice Address - Street 1:10800 MAGNOLIA AVE
Practice Address - Street 2:DEPARTMENT OF GENERAL SURGERY
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3043
Practice Address - Country:US
Practice Address - Phone:951-353-3606
Practice Address - Fax:951-353-5406
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG861132086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
E99253Medicare UPIN