Provider Demographics
NPI:1205032984
Name:KIM, SEUNG W (MD)
Entity type:Individual
Prefix:
First Name:SEUNG
Middle Name:W
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 1:7780 BRIER CREEK PKWY
Mailing Address - Street 2:STE. 200
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-7849
Mailing Address - Country:US
Mailing Address - Phone:919-596-3400
Mailing Address - Fax:919-596-3499
Practice Address - Street 1:7780 BRIER CREEK PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-7869
Practice Address - Country:US
Practice Address - Phone:919-596-3400
Practice Address - Fax:919-596-3499
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-01151207LP2900X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
1534EOtherBCBS NC
NC5912910Medicaid
2075198Medicare PIN