Provider Demographics
NPI:1902071301
Name:THOMPSON, KIM YUNG SOOK (DO)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:YUNG SOOK
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2275 DEMING WAY
Mailing Address - Street 2:SUITE 240
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5527
Mailing Address - Country:US
Mailing Address - Phone:608-662-7762
Mailing Address - Fax:608-662-7769
Practice Address - Street 1:2275 DEMING WAY
Practice Address - Street 2:SUITE 240
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-5527
Practice Address - Country:US
Practice Address - Phone:608-662-7762
Practice Address - Fax:608-662-7769
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI49839-21207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI49839-21OtherMEDICAL LICENSE