Provider Demographics
NPI:1740227339
Name:KIM, MIN SUN (MD)
Entity Type:Individual
Prefix:DR
First Name:MIN
Middle Name:SUN
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 1:6201 GREENLEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2004
Mailing Address - Country:US
Mailing Address - Phone:410-933-2704
Mailing Address - Fax:
Practice Address - Street 1:9715 MEDICAL CENTER DR STE 233
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6302
Practice Address - Country:US
Practice Address - Phone:240-403-0621
Practice Address - Fax:240-826-5521
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD66122208600000X
MDD0066122208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
005229M44Medicare ID - Type Unspecified
I13954Medicare UPIN
005229M44Medicare ID - Type Unspecified