Provider Demographics
NPI:1780975417
Name:KIM, MINA SOON (MD)
Entity type:Individual
Prefix:MS
First Name:MINA
Middle Name:SOON
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9411 N OAK TRFY STE LL1
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-2262
Mailing Address - Country:US
Mailing Address - Phone:816-691-1655
Mailing Address - Fax:816-436-2743
Practice Address - Street 1:2700 CLAY EDWARDS DR STE 240
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3254
Practice Address - Country:US
Practice Address - Phone:816-691-2021
Practice Address - Fax:816-346-7690
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2023011513207L00000X
390200000X
DEC1-0011319207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program