Healthcare Provider Details

I. General information

NPI: 1215106455
Provider Name (Legal Business Name): SUNG HAN KIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 LAUKAHI ST
HONOLULU HI
96821-1408
US

IV. Provider business mailing address

1350 LAUKAHI ST
HONOLULU HI
96821-1408
US

V. Phone/Fax

Practice location:
  • Phone: 617-999-5524
  • Fax:
Mailing address:
  • Phone: 617-999-5524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD447211
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberL-228909
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberC202882
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number260836
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD0070348
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: