Provider Demographics
NPI:1215106455
Name:KIM, SUNG HAN (MD)
Entity type:Individual
Prefix:
First Name:SUNG
Middle Name:HAN
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3400 SPRUCE ST.
Mailing Address - Street 2:1 SILVERSTEIN
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104
Mailing Address - Country:US
Mailing Address - Phone:215-662-3005
Mailing Address - Fax:845-338-5616
Practice Address - Street 1:3400 SPRUCE ST.
Practice Address - Street 2:1 SILVERSTEIN
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-662-3005
Practice Address - Fax:845-340-4501
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MAL-2289092085R0202X
MDD00703482085R0202X
NY2608362085R0202X
PAMD4472112085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY260836OtherNYS LICENSE