Provider Demographics
NPI:1255474359
Name:KIM-ASHCHI, SUNWOOK (MD)
Entity type:Individual
Prefix:
First Name:SUNWOOK
Middle Name:
Last Name:KIM-ASHCHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6355 S BUFFALO DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2133
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:
Practice Address - Street 1:5320 S RAINBOW BLVD STE 182
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1896
Practice Address - Country:US
Practice Address - Phone:702-255-3547
Practice Address - Fax:702-212-4993
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77123207V00000X
NV24782207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV24782OtherSTATE LICENSE
FL261872900Medicaid
592292041OtherTAX ID
592292041OtherTAX ID