Provider Demographics
NPI:1558442038
Name:KIM, SUCK WON (MD)
Entity Type:Individual
Prefix:
First Name:SUCK
Middle Name:WON
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:420 DELAWARE ST SE
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-273-8700
Mailing Address - Fax:
Practice Address - Street 1:2312 SOUTH 6TH STREET
Practice Address - Street 2:SUITE F256 / 2B WEST
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-273-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN200832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31694300Medicaid
ND10387Medicaid
MN1507269OtherMEDICA-CHOICE
260026103OtherRR MEDICARE
IA0500298Medicaid
765590OtherARAZ
SD7777470Medicaid
MN009760800Medicaid
MN108091OtherU CARE
MN5T619KIOtherBCBS
MN088963OtherFAIRVIEW
MN1009170OtherPREFERRED ONE
MN1507269OtherMEDICA-PRIMARY
MNHP22352OtherHEALTH PARTNERS
MN1507269OtherMEDICA-CHOICE
SD7777470Medicaid