Provider Demographics
NPI:1649570755
Name:KIM, SANG WAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SANG
Middle Name:WAN
Last Name:KIM
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 1:913 WHISPERING RIDGE LANE
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015
Mailing Address - Country:US
Mailing Address - Phone:410-838-0018
Mailing Address - Fax:410-838-0018
Practice Address - Street 1:7305 BROOKVIEW RD UNIT 306
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6080
Practice Address - Country:US
Practice Address - Phone:410-838-0018
Practice Address - Fax:410-838-0018
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0015103207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine