Healthcare Provider Details

I. General information

NPI: 1760679351
Provider Name (Legal Business Name): SANGAE KIM-PARK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 MEDICAL PARK DR E SUITE 312
BIRMINGHAM AL
35235-3430
US

IV. Provider business mailing address

52 MEDICAL PARK DR E SUITE 312
BIRMINGHAM AL
35235-3430
US

V. Phone/Fax

Practice location:
  • Phone: 205-702-6602
  • Fax: 888-206-1336
Mailing address:
  • Phone: 205-702-6602
  • Fax: 888-206-1336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number28332
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28332
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: