Provider Demographics
NPI:1871013631
Name:KIM, SION (MD)
Entity Type:Individual
Prefix:
First Name:SION
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:6355 S BUFFALO DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2133
Mailing Address - Country:US
Mailing Address - Phone:792-216-3346
Mailing Address - Fax:702-216-3346
Practice Address - Street 1:2550 NATURE PARK DR STE 235
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-3205
Practice Address - Country:US
Practice Address - Phone:702-948-1150
Practice Address - Fax:702-688-8862
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NETEP8002207Q00000X
TXS8456207Q00000X
NV22243207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV22243OtherSTATE LICENSE
NV1871013631Medicaid