Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | MD034173E | PA |
NPI | 1477579530 |
---|---|
Provider Name | Dr. Sung M. Kim |
First Address | Philadelphia, PA 19107-4824 |
Second Address | Philadelphia, PA 19107-4824 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 19/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001147366 | (05) | PA |
6377904 | (05) | NJ |