MEDICARE: DR. SUE H KIM PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	LP955	NH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	RE615801	OTHER	NH	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649249889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUE H KIM PHD

Provider Business Mailing Address
First Line	:	PO BOX 844
Second Line	:	ONE CHALET DRIVE, SUITE 106
City	:	WILTON
State	:	NH
Zip	:	03086-0844
Country	:	US
Telephone Number	:	603-654-2181
Fax Number	:	603-654-2182

Provider Business Practice Location Address
First Line	:	ONE CHALET DR STE 106
Second Line	:	THE SUMMIT EXECUTIVE OFFICES
City	:	WILTON
State	:	NH
Zip	:	03086-0844
Country	:	US
Telephone Number	:	603-654-2181
Fax Number	:	603-654-2182

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	12/30/2010

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