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General NPI Number Information
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NPI Number | 1982697363
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Entity Type | Individual
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Provider Name | SUSAN KIM M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/31/2005
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Last Update Date | 02/14/2022
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Provider Practice Location Address
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Address Line | 80 SEYMOUR ST
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City | HARTFORD
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State | CT
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Zip | 06102-8000
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Country | US
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Telephone | 860-545-2803
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Fax | 860-545-1500
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Provider Business Mailing Address
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Address Line | 252 BEAVER BROOK RD
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City | LYME
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State | CT
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Zip | 06371-3204
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Country | US
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Telephone | 860-402-1090
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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 | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 040358
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License Number State | CT
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