Provider Demographics
NPI:1508864968
Name:KIM, SOLA (MD)
Entity Type:Individual
Prefix:MS
First Name:SOLA
Middle Name:
Last Name:KIM
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 1:9150 MEDCOM ST
Mailing Address - Street 2:STE B
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-7108
Mailing Address - Country:US
Mailing Address - Phone:843-572-3330
Mailing Address - Fax:843-572-1255
Practice Address - Street 1:9150 MEDCOM ST
Practice Address - Street 2:STE B
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-7108
Practice Address - Country:US
Practice Address - Phone:843-572-3330
Practice Address - Fax:843-572-1255
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15187207RC0200X, 207RP1001X
SC015187207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC151873Medicaid
SCG02694Medicare UPIN
SCG02694Medicare UPIN