Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 34006602 | OH |
N | 208600000X | Surgeon | 34006602 | OH |
Y | 2086S0129X | Vascular Surgeon | 34006602 | OH |
NPI | 1043385529 |
---|---|
Provider Name | Dr. Sang Won Dacri-Kim |
First Address | Newark, OH 43055 |
Second Address | Newark, OH 43055 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 23/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2028577 | (05) | OH |
G53636 | (02) | OH |
P00397004 | RAILROAD MEDICARE (01) | OH |