Provider Demographics
NPI:1427189240
Name:RHIM, SOOK JA (MD)
Entity Type:Individual
Prefix:
First Name:SOOK
Middle Name:JA
Last Name:RHIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:658 KINGSLEY TRL
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-2319
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:DETROIT HEALTH DEPT. - GRACE ROSS HEALTH CENTER
Practice Address - Street 2:14585 GREENFIELD ROAD
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227
Practice Address - Country:US
Practice Address - Phone:313-852-4445
Practice Address - Fax:313-852-4468
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301033406390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11286883OtherCAQH
MI5025110Medicare ID - Type Unspecified