Provider Demographics
NPI:1154497154
Name:KIM-MILLER, SALLY H (MD)
Entity type:Individual
Prefix:DR
First Name:SALLY
Middle Name:H
Last Name:KIM-MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1626 FEDERAL AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-4235
Mailing Address - Country:US
Mailing Address - Phone:206-329-1526
Mailing Address - Fax:206-329-1871
Practice Address - Street 1:1626 FEDERAL AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-4235
Practice Address - Country:US
Practice Address - Phone:206-329-1526
Practice Address - Fax:206-329-1871
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA21601207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAD33144Medicare UPIN