Provider Demographics
NPI:1386733129
Name:KIM, SOPHIA HYANG (MD)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:HYANG
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 SAINT PETER ST
Mailing Address - Street 2:250
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-1001
Mailing Address - Country:US
Mailing Address - Phone:651-645-9600
Mailing Address - Fax:651-645-9605
Practice Address - Street 1:514 SAINT PETER ST
Practice Address - Street 2:250
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-1001
Practice Address - Country:US
Practice Address - Phone:651-645-9600
Practice Address - Fax:651-645-9605
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN42442207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN42442OtherMEDICAL LICENSE
MN42442OtherMEDICAL LICENSE
1100065700347Medicare ID - Type Unspecified