Provider Demographics
NPI:1922041839
Name:KIM, SUCKHONG BRIAN (MD)
Entity Type:Individual
Prefix:
First Name:SUCKHONG
Middle Name:BRIAN
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 1:1540 E EVERGREEN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-4300
Mailing Address - Country:US
Mailing Address - Phone:417-823-2900
Mailing Address - Fax:417-886-2774
Practice Address - Street 1:1540 E EVERGREEN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-4300
Practice Address - Country:US
Practice Address - Phone:417-823-2900
Practice Address - Fax:417-886-2774
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5J91207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO039014838Medicaid
MO202657011Medicaid
ARP00958203OtherRR MEDICARE
MO1922041839Medicaid
107067OtherBLUE CROSS/BLUE SHIELD
AR188306001Medicaid
P00361138OtherRR MEDICARE
MO1922041839Medicaid
107067OtherBLUE CROSS/BLUE SHIELD
AR5AJ99G073Medicare PIN
ARP00958203OtherRR MEDICARE
MO202657011Medicaid