Provider Demographics
NPI:1720214919
Name:KIM, HEESUNG SEAN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:HEESUNG
Middle Name:SEAN
Last Name:KIM
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:106 PINE BLUFF RD STE 11
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-7161
Mailing Address - Country:US
Mailing Address - Phone:410-742-0770
Mailing Address - Fax:410-742-2589
Practice Address - Street 1:106 PINE BLUFF RD STE 11
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-7161
Practice Address - Country:US
Practice Address - Phone:410-742-0770
Practice Address - Fax:410-742-2589
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003939363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical