Provider Demographics
NPI:1669886453
Name:KIM, HEE SUK
Entity type:Individual
Prefix:
First Name:HEE
Middle Name:SUK
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5560 NORBECK RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-2441
Mailing Address - Country:US
Mailing Address - Phone:301-460-1120
Mailing Address - Fax:301-460-8216
Practice Address - Street 1:5560 NORBECK RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20853-2441
Practice Address - Country:US
Practice Address - Phone:301-460-1120
Practice Address - Fax:301-460-8216
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12163183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist