Provider Demographics
NPI:1205481041
Name:SUNNY S. KIM, MD PA
Entity type:Organization
Organization Name:SUNNY S. KIM, MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SVP/PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARYA
Authorized Official - Middle Name:C
Authorized Official - Last Name:LYDEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-405-9760
Mailing Address - Street 1:1601 HIGHWAY 13 E STE 100
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-6847
Mailing Address - Country:US
Mailing Address - Phone:320-763-8888
Mailing Address - Fax:952-582-1607
Practice Address - Street 1:1601 HIGHWAY 13 E STE 100
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-6847
Practice Address - Country:US
Practice Address - Phone:320-763-8888
Practice Address - Fax:952-582-1607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-08
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1932303526OtherDR. HAMID R. ABBASI
MN1659301992OtherFACILITY