Provider Demographics
NPI:1629061247
Name:KIM, SUE YEUN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUE
Middle Name:YEUN
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 HOVERHILL ST
Mailing Address - Street 2:ANDOVER OB/GYN
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810
Mailing Address - Country:US
Mailing Address - Phone:978-475-2731
Mailing Address - Fax:978-975-2536
Practice Address - Street 1:140 HOVERHILL ST
Practice Address - Street 2:ANDOVER OB/GYN
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810
Practice Address - Country:US
Practice Address - Phone:978-475-2731
Practice Address - Fax:978-975-2536
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD11434207V00000X
MA232566207V00000X
NH14627207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology