Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 31927 | MN |
NPI | 1114989555 |
---|---|
Provider Name | Dr. Sunny S Kim |
First Address | Alexandria, MN 56308-6196 |
Second Address | Burnsville, MN 55337-5105 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2006 |
Last Update Date | 13/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1748051 | (05) | MN |
31927 | STATE LICENSE # (01) | MN |
D81801 | (02) | MN |