Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | MD048074L | PA |
NPI | 1124091764 |
---|---|
Provider Name | Dr. Sun Yong Kim |
First Address | Fort Bragg, NC 28310 |
Second Address | Fort Bragg, NC 28310-7301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2006 |
Last Update Date | 08/07/2007 |