Provider Demographics
NPI:1992942148
Name:KIM, SUN S (RN PC)
Entity type:Individual
Prefix:
First Name:SUN
Middle Name:S
Last Name:KIM
Suffix:
Gender:F
Credentials:RN PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:328 SHREWSBURY ST
Practice Address - Street 2:DEPARTMENT OF PSYCHIATRY
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-4613
Practice Address - Country:US
Practice Address - Phone:508-334-2537
Practice Address - Fax:508-334-4320
Is Sole Proprietor?:No
Enumeration Date:2009-01-09
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA279972364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA279972OtherMASSACHUSETTS LICENSE