Provider Demographics
NPI:1659301992
Name:SUNNY S. KIM, MD PA
Entity Type:Organization
Organization Name:SUNNY S. KIM, MD PA
Other - Org Name:INSPIRED SPINE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP/PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARYA
Authorized Official - Middle Name:C
Authorized Official - Last Name:LYDEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-405-9760
Mailing Address - Street 1:1601 HIGHWAY 13 E STE 211
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-5105
Mailing Address - Country:US
Mailing Address - Phone:952-405-9760
Mailing Address - Fax:855-430-6952
Practice Address - Street 1:1601 HIGHWAY 13 E STE 100
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-6847
Practice Address - Country:US
Practice Address - Phone:320-763-8888
Practice Address - Fax:952-405-9760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN54789207T00000X
MN31927207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN963393600Medicaid
MN178083200Medicaid
MN20011924OtherRAILROAD MEDICARE
MN250003199OtherRAILROAD MEDICARE
MN6727410001OtherNSC
MND81801Medicare UPIN
MN200001715Medicare ID - Type Unspecified
MNA94902Medicare UPIN
MN963393600Medicaid