Provider Demographics
NPI:1427282714
Name:KIM, SUEJIN SON (MD)
Entity type:Individual
Prefix:
First Name:SUEJIN
Middle Name:SON
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 1:2585 SAMARITAN DR FL 2
Mailing Address - Street 2:STE 25
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4114
Mailing Address - Country:US
Mailing Address - Phone:650-736-5555
Mailing Address - Fax:
Practice Address - Street 1:2585 SAMARITAN DR FL 2
Practice Address - Street 2:STE 25
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4114
Practice Address - Country:US
Practice Address - Phone:650-736-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-14
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95237207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology