Provider Demographics
NPI:1578678405
Name:SIM, JAMES SUNGMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:SUNGMIN
Last Name:SIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5131 ODONOVAN DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4791
Mailing Address - Country:US
Mailing Address - Phone:225-767-4893
Mailing Address - Fax:225-767-5494
Practice Address - Street 1:5131 ODONOVAN DR STE 100
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4791
Practice Address - Country:US
Practice Address - Phone:225-767-4893
Practice Address - Fax:225-767-5494
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.206715207RN0300X
GA059021207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2375857Medicaid
GA735326951PMedicaid
GA735326951WMedicaid
GA735326951DMedicaid
GA735326951FMedicaid
GA735326951LMedicaid
GA735326951AMedicaid
GA735326951HMedicaid
GA735326951OMedicaid
GA735326951SMedicaid
GA735326951UMedicaid
GA735326951IMedicaid
GA735326951QMedicaid
GA735326951NMedicaid
GA735326951VMedicaid
GA735326951YMedicaid
GA735326951GMedicaid
GA735326951MMedicaid
GA735326951EMedicaid
GA735326951JMedicaid
GA735326951XMedicaid
GA735326951FMedicaid