Provider Demographics
NPI:1205877859
Name:KIM, SUH KANG (MD)
Entity type:Individual
Prefix:DR
First Name:SUH
Middle Name:KANG
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7600 OSLER DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7735
Mailing Address - Country:US
Mailing Address - Phone:410-337-8598
Mailing Address - Fax:410-296-3444
Practice Address - Street 1:7600 OSLER DR
Practice Address - Street 2:SUITE 310
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7735
Practice Address - Country:US
Practice Address - Phone:410-337-8598
Practice Address - Fax:410-296-3444
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2013-08-09
Deactivation Date:2013-07-16
Deactivation Code:
Reactivation Date:2013-08-07
Provider Licenses
StateLicense IDTaxonomies
MDD0012726208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD005701100Medicaid
MD005701100Medicaid