Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 4301097602 | MI |
NPI | 1356441646 |
---|---|
Provider Name | Dr. Steve Ho-Suk Kim |
First Address | Troy, MI 48083-1189 |
Second Address | Detroit, MI 48201-2013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 09/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4301097602 | MICHIGAN DEPARTMENT OF COMMUNITY HEALTH (01) | MI |
7653409 | (05) | NJ |
BK6091538 | DEA (01) | NJ |
G78911 | (02) | NJ |