Healthcare Provider Details

I. General information

NPI: 1730372368
Provider Name (Legal Business Name): SEIHA THIOUNN KIM D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 04/28/2022
Certification Date: 04/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER BLVD DEPARTMENT OF ANESTHESIOLOGY
WINSTON SALEM NC
27157-0001
US

IV. Provider business mailing address

1 MEDICAL CENTER BLVD DEPARTMENT OF ANESTHESIOLOGY
WINSTON SALEM NC
27157-0001
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-4498
  • Fax:
Mailing address:
  • Phone: 336-716-4498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number191196
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS41425
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number87524
License Number StateSC
# 4
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number2017-00315
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: