Provider Demographics
NPI:1538652631
Name:KIM, SUNG CHOL (PA)
Entity Type:Individual
Prefix:
First Name:SUNG
Middle Name:CHOL
Last Name:KIM
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210TH FA BDE
Mailing Address - Street 2:UNIT # 15564
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96224
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:210TH FA BDE
Practice Address - Street 2:UNIT # 15564
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96224
Practice Address - Country:US
Practice Address - Phone:312-730-2538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2018-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No171000000XOther Service ProvidersMilitary Health Care Provider