Provider Demographics
NPI:1538133723
Name:KIM, SANG W (MD)
Entity Type:Individual
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First Name:SANG
Middle Name:W
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3577 W THIRTEEN MILE RD
Mailing Address - Street 2:#301
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073
Mailing Address - Country:US
Mailing Address - Phone:248-551-0669
Mailing Address - Fax:248-551-0058
Practice Address - Street 1:3577 W THIRTEEN MILE RD
Practice Address - Street 2:#301
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073
Practice Address - Country:US
Practice Address - Phone:248-551-0669
Practice Address - Fax:248-551-0058
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2020-10-22
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Provider Licenses
StateLicense IDTaxonomies
MISK091209208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1538133723Medicaid
MI1538133723Medicaid