Provider Demographics
NPI:1588845812
Name:SUE E KIM M.D., LLC
Entity type:Organization
Organization Name:SUE E KIM M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONE PERSON LLC
Authorized Official - Prefix:DR
Authorized Official - First Name:SUE
Authorized Official - Middle Name:E
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-321-5502
Mailing Address - Street 1:1205 YORK RD STE 35
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6211
Mailing Address - Country:US
Mailing Address - Phone:410-321-5502
Mailing Address - Fax:410-785-1988
Practice Address - Street 1:1205 YORK RD STE 35
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6211
Practice Address - Country:US
Practice Address - Phone:410-321-5502
Practice Address - Fax:410-785-1988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0041868261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH37315Medicare UPIN
MD575MMedicare PIN