Healthcare Provider Details

I. General information

NPI: 1427189240
Provider Name (Legal Business Name): SOOK JA RHIM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DETROIT HEALTH DEPT. - GRACE ROSS HEALTH CENTER 14585 GREENFIELD ROAD
DETROIT MI
48227
US

IV. Provider business mailing address

658 KINGSLEY TRL
BLOOMFIELD HILLS MI
48304-2319
US

V. Phone/Fax

Practice location:
  • Phone: 313-852-4445
  • Fax: 313-852-4468
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301033406
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: