Provider Demographics
NPI:1982634507
Name:KIM, SUSAN H (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:H
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10117 NE 58TH ST
Mailing Address - Street 2:STE 200
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-7450
Mailing Address - Country:US
Mailing Address - Phone:425-821-6363
Mailing Address - Fax:425-821-4804
Practice Address - Street 1:10117 NE 58TH ST
Practice Address - Street 2:STE 200
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-7450
Practice Address - Country:US
Practice Address - Phone:425-821-6363
Practice Address - Fax:425-821-4804
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00037239207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA50D0966896OtherCLIA
WAMD00037239OtherWA LICENSE NUMBER
WABK5918151OtherDEA NUMBER
WAG8918029Medicare PIN
WAG93869Medicare UPIN