Provider Demographics
NPI:1932118973
Name:KIM, SUNG UK (MD)
Entity Type:Individual
Prefix:
First Name:SUNG
Middle Name:UK
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13656 39TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5508
Mailing Address - Country:US
Mailing Address - Phone:646-450-7345
Mailing Address - Fax:888-388-5171
Practice Address - Street 1:13656 39TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5508
Practice Address - Country:US
Practice Address - Phone:646-450-7345
Practice Address - Fax:888-388-5171
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1058602085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00185382Medicaid
NY00185382Medicaid
B78004Medicare UPIN