Provider Demographics
NPI:1841424074
Name:KIM, SUNG T (MD)
Entity Type:Individual
Prefix:DR
First Name:SUNG
Middle Name:T
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SUNG
Other - Middle Name:TAE
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:271 GROVE AVE STE E
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-1730
Mailing Address - Country:US
Mailing Address - Phone:973-559-3700
Mailing Address - Fax:833-488-1213
Practice Address - Street 1:200 HIGHLAND AVE STE 100B
Practice Address - Street 2:
Practice Address - City:GLEN RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07028-1521
Practice Address - Country:US
Practice Address - Phone:973-969-3800
Practice Address - Fax:833-488-1213
Is Sole Proprietor?:No
Enumeration Date:2009-05-01
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09997400207Q00000X
VA0101248424207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine