Provider Demographics
NPI:1891794814
Name:KIM, HYUNG SUK (DO)
Entity Type:Individual
Prefix:DR
First Name:HYUNG
Middle Name:SUK
Last Name:KIM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:HYUNG (PAUL)
Other - Middle Name:SUK
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5450 FRANTZ RD STE 360
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4141
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7853 PACER DR STE 3A
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-7571
Practice Address - Country:US
Practice Address - Phone:614-533-3470
Practice Address - Fax:614-533-0069
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-6545207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2257525Medicaid
OH311211539026OtherCARESOURCE
OH2257525Medicaid
OHH41721Medicare UPIN