Provider Demographics
NPI:1336345792
Name:KIM, SUEZIE (MD)
Entity Type:Individual
Prefix:
First Name:SUEZIE
Middle Name:
Last Name:KIM
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 1:395 N SILVERBELL RD STE 101
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-2718
Mailing Address - Country:US
Mailing Address - Phone:520-882-0696
Mailing Address - Fax:520-624-0024
Practice Address - Street 1:395 N SILVERBELL RD STE 101
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2718
Practice Address - Country:US
Practice Address - Phone:520-882-0696
Practice Address - Fax:520-624-0024
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ51011207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ145249Medicaid
AZZ192791Medicare PIN