Healthcare Provider Details

I. General information

NPI: 1134459969
Provider Name (Legal Business Name): WOOK KIM MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2009
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29877 TELEGRAPH RD SUITE 401
SOUTHFIELD MI
48034-7661
US

IV. Provider business mailing address

29877 TELEGRAPH RD SUITE 401
SOUTHFIELD MI
48034-7661
US

V. Phone/Fax

Practice location:
  • Phone: 248-651-8344
  • Fax: 248-651-8024
Mailing address:
  • Phone: 248-651-8344
  • Fax: 248-651-8024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number036156
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number4301099580
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number5315052216
License Number StateMI

VIII. Authorized Official

Name: SIMRAT DHILLON
Title or Position: OFFICE MANAGER
Credential:
Phone: 248-651-8344