Provider Demographics
NPI:1952515322
Name:KIM, LIZA SUNMIN (MD)
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:SUNMIN
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:11230 GOLD EXPRESS DR # 310-169
Mailing Address - Street 2:
Mailing Address - City:GOLD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95670-4484
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:87 SCRIPPS DR STE 310
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6318
Practice Address - Country:US
Practice Address - Phone:916-705-2798
Practice Address - Fax:916-273-5646
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2023-11-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA116202208200000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX218544901Medicaid
CAA116202OtherMEDICAL STATE LICENSE
TX1952515322OtherBLUE CROSS BLUE SHIELD