Healthcare Provider Details

I. General information

NPI: 1205481041
Provider Name (Legal Business Name): SUNNY S. KIM, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 HIGHWAY 13 E STE 100
BURNSVILLE MN
55337-6847
US

IV. Provider business mailing address

1601 HIGHWAY 13 E STE 100
BURNSVILLE MN
55337-6847
US

V. Phone/Fax

Practice location:
  • Phone: 320-763-8888
  • Fax: 952-582-1607
Mailing address:
  • Phone: 320-763-8888
  • Fax: 952-582-1607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARYA C LYDEEN
Title or Position: SVP/PRACTICE ADMINISTRATOR
Credential:
Phone: 952-405-9760