Doctor Name: | SUK CHUL KIM |
NPI Number: | 1508005380 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 256254 |
Business Practice Address: | 1101 Glendale Road Ste. 110 Valparaiso, IN - 46383 |
Business Phone Number: | 2194776828 |
Business Fax Number: | 2194776832 |
Mailing Address: | 757 45th Street, Ste. 201 MUNSTER |
State: | IN |
Postal Code: | 46321 |
Phone Number: | 2199225550 |
Fax Number: | 2199225555 |
NPI Enumeration Date: | 02/18/2009 |
NPI Last Update Date: | 11/09/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | 256254 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NY |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |