Healthcare Provider Details

I. General information

NPI: 1427686575
Provider Name (Legal Business Name): SUNNY S. KIM, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
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: 524-059-7609
  • Fax: 855-430-6952
Mailing address:
  • Phone: 952-405-9760
  • Fax: 855-430-6952

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: NICOLE NAVARRETE
Title or Position: BUSINESS MANAGER
Credential:
Phone: 651-456-8795