Provider Demographics
NPI:1982603619
Name:KIM, SUSAN MARY (NP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MARY
Last Name:KIM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:1350 LOCUST ST STE 105
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15219-4738
Mailing Address - Country:US
Mailing Address - Phone:412-232-8840
Mailing Address - Fax:412-232-3690
Practice Address - Street 1:1350 LOCUST ST STE 105
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15219-4738
Practice Address - Country:US
Practice Address - Phone:412-232-8840
Practice Address - Fax:412-232-3690
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP000893C363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA089141H10Medicare ID - Type Unspecified