Provider Demographics
NPI:1568022242
Name:KIM, MIKE SUNWOO (DO)
Entity Type:Individual
Prefix:
First Name:MIKE
Middle Name:SUNWOO
Last Name:KIM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 FISHER ST RM 1G123
Mailing Address - Street 2:
Mailing Address - City:KEESLER AFB
Mailing Address - State:MS
Mailing Address - Zip Code:39534-2519
Mailing Address - Country:US
Mailing Address - Phone:282-376-0577
Mailing Address - Fax:
Practice Address - Street 1:301 FISHER ST RM 1G123
Practice Address - Street 2:
Practice Address - City:KEESLER AFB
Practice Address - State:MS
Practice Address - Zip Code:39534-2519
Practice Address - Country:US
Practice Address - Phone:228-376-0577
Practice Address - Fax:228-376-0103
Is Sole Proprietor?:No
Enumeration Date:2019-06-16
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA91050207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine