Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 01040301 | IN |
NPI | 1033119417 |
---|---|
Provider Name | Dr. Sang Hoon Kim |
First Address | Indianapolis, IN 46260-5381 |
Second Address | Indianapolis, IN 46260-5381 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2005 |
Last Update Date | 24/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100196490C | (05) | IN |
E46058 | (02) | IN |