Healthcare Provider Details

I. General information

NPI: 1750575346
Provider Name (Legal Business Name): SARAH SUNJUNG KIM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 02/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 S BRYN MAWR AVE
BRYN MAWR PA
19010-3121
US

IV. Provider business mailing address

PO BOX 191
ROCKLAND DE
19732-0191
US

V. Phone/Fax

Practice location:
  • Phone: 410-526-3000
  • Fax: 302-651-4945
Mailing address:
  • Phone: 610-526-3000
  • Fax: 302-651-4945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM5292
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD436831
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0077PT
Identifier TypeOTHER
Identifier StateTX
Identifier IssuerBCBS
# 2
Identifier186331801
Identifier TypeMEDICAID
Identifier StateTX
Identifier Issuer
# 3
Identifier8AL503
Identifier TypeOTHER
Identifier StateTX
Identifier IssuerBCBS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: