Provider Demographics
NPI:1477557270
Name:KIM, SUK KI (MD)
Entity Type:Individual
Prefix:DR
First Name:SUK
Middle Name:KI
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3332 VILLA PT
Mailing Address - Street 2:STE 104
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-7818
Mailing Address - Country:US
Mailing Address - Phone:270-684-5679
Mailing Address - Fax:270-684-5753
Practice Address - Street 1:3332 VILLA PT
Practice Address - Street 2:STE 104
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-7818
Practice Address - Country:US
Practice Address - Phone:270-684-5679
Practice Address - Fax:270-684-5753
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY17728208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100001550AMedicaid
KY64177280Medicaid
KY64177280Medicaid
KY917701Medicare PIN
KY0755701Medicare PIN