Healthcare Provider Details

I. General information

NPI: 1720923147
Provider Name (Legal Business Name): SADO S KIM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HWY 30 W
NEW ALBANY MS
38652-3197
US

IV. Provider business mailing address

306 LIBERTY VIEW LN
LYNCHBURG VA
24502-2291
US

V. Phone/Fax

Practice location:
  • Phone: 662-538-7631
  • Fax:
Mailing address:
  • Phone: 434-592-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: