Provider Demographics
NPI:1417664467
Name:SUSAN SOOYOUNG KIM MD PHD P.C.
Entity Type:Organization
Organization Name:SUSAN SOOYOUNG KIM MD PHD P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF PROFESSIONAL CORPORATION
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:SOOYOUNG
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-759-6058
Mailing Address - Street 1:PO BOX 21187
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98111-3187
Mailing Address - Country:US
Mailing Address - Phone:206-759-6058
Mailing Address - Fax:
Practice Address - Street 1:13107 121ST WAY NE STE A
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3051
Practice Address - Country:US
Practice Address - Phone:206-759-6058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty