Provider Demographics
NPI:1134459969
Name:WOOK KIM MD PC
Entity type:Organization
Organization Name:WOOK KIM MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SIMRAT
Authorized Official - Middle Name:
Authorized Official - Last Name:DHILLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-651-8344
Mailing Address - Street 1:29877 TELEGRAPH RD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-7661
Mailing Address - Country:US
Mailing Address - Phone:248-651-8344
Mailing Address - Fax:248-651-8024
Practice Address - Street 1:29877 TELEGRAPH RD
Practice Address - Street 2:SUITE 401
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-7661
Practice Address - Country:US
Practice Address - Phone:248-651-8344
Practice Address - Fax:248-651-8024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-29
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301099580332B00000X
MI53150522163336C0002X
MI036156174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3079621Medicaid
MI036156OtherSTATE LICENSE
MI3079621Medicaid