Healthcare Provider Details

I. General information

NPI: 1871570879
Provider Name (Legal Business Name): SUK HEE KYMN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 CARPENTER RD BUILDING 525
FT MYER VA
22211-1009
US

IV. Provider business mailing address

8721 RIDGE RD
BETHESDA MD
20817-3233
US

V. Phone/Fax

Practice location:
  • Phone: 703-696-3614
  • Fax: 703-696-9248
Mailing address:
  • Phone: 301-469-7015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberMD031231L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: