| Doctor Name: | SUSIE S. KIM |
| NPI Number: | 1003816232 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 712630 |
| Business Practice Address: | 7501 Lakeview Pkwy Suite 245 Rowlett, TX - 750889322 |
| Business Phone Number: | 5627148609 |
| Business Fax Number: | 2062023378 |
| Mailing Address: | Po Box 570492, DALLAS |
| State: | TX |
| Postal Code: | 753570492 |
| Phone Number: | 5627148609 |
| Fax Number: | 2062023378 |
| NPI Enumeration Date: | 07/29/2005 |
| NPI Last Update Date: | 07/14/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 712630 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |