MEDICARE: SARAH CHONG KIM PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA9112015	FL
2	363AM0700X	Medical Physician Assistant	PA12792	TX

General Provider Information

NPI Number	:	1083264766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH CHONG KIM PA-C

Provider Business Mailing Address
First Line	:	2051 WITTINGTON PL APT 3116
Second Line	:
City	:	FARMERS BRANCH
State	:	TX
Zip	:	75234-1943
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3501 N MACARTHUR BLVD STE 330
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75062-3611
Country	:	US
Telephone Number	:	972-607-2340
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2019
Last Update Date	:	01/21/2021

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Directions to “ SARAH CHONG KIM PA-C” Practice Location

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