Provider Demographics
NPI:1154841948
Name:KIM, SUNG CHEOL (PMHNP)
Entity type:Individual
Prefix:
First Name:SUNG CHEOL
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 BYRD AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3033
Mailing Address - Country:US
Mailing Address - Phone:804-592-6311
Mailing Address - Fax:844-744-0273
Practice Address - Street 1:1900 BYRD AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3033
Practice Address - Country:US
Practice Address - Phone:804-592-6311
Practice Address - Fax:844-744-0273
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-22
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174971363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health