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General NPI Number Information
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NPI Number | 1104807676
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Entity Type | Individual
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Provider Name | SUSAN S KIM M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/10/2005
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Last Update Date | 03/15/2023
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Provider Practice Location Address
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Address Line | 13107 121ST WAY NE
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City | KIRKLAND
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State | WA
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Zip | 98034-3051
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Country | US
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Telephone | 206-759-6058
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 21187
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City | SEATTLE
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State | WA
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Zip | 98111-3187
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Country | US
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Telephone | 206-759-6058
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | A87629
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License Number State | CA
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