MEDICARE: DR. SUN YONG KIM M.D.

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	207U00000X	Nuclear Medicine Physician	MD048074L	PA

General Provider Information

NPI Number	:	1124091764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUN YONG KIM M.D.

Provider Business Mailing Address
First Line	:	2817 REILLY ROAD MCXC-COD CREDENTIALS
Second Line	:	WOMACK ARMY MEDICAL CENTER
City	:	FORT BRAGG
State	:	NC
Zip	:	28310
Country	:	US
Telephone Number	:	910-907-8922
Fax Number	:	910-907-6069

Provider Business Practice Location Address
First Line	:	DEPARTMENT OF THE ARMY WAMC STOP A 2817 REILLY ROAD
Second Line	:	ATTN: SUN YONG KIM MCXC-RAD
City	:	FORT BRAGG
State	:	NC
Zip	:	28310-7301
Country	:	US
Telephone Number	:	910-907-6993
Fax Number	:	910-907-6985

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

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	07/08/2007

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