Provider Demographics
NPI:1629128038
Name:KIM, HYO S (MD)
Entity Type:Individual
Prefix:DR
First Name:HYO
Middle Name:S
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 1:37800 MOUND RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-4128
Mailing Address - Country:US
Mailing Address - Phone:586-939-7223
Mailing Address - Fax:
Practice Address - Street 1:37800 MOUND RD
Practice Address - Street 2:SUITE 1
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4128
Practice Address - Country:US
Practice Address - Phone:586-939-7223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301031988207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2122058Medicaid
MIE30658Medicare UPIN
MION69940Medicare ID - Type Unspecified