MEDICARE: S AND S KIM GROUP PC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	363A00000X	Physician Assistant
2	363LF0000X	Family Nurse Practitioner
3	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1134323561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S AND S KIM GROUP PC

Provider Business Mailing Address
First Line	:	1450 W HORIZON RIDGE PKWY STE B305 # 570
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89012-4480
Country	:	US
Telephone Number	:	702-566-5445
Fax Number	:	702-448-7221

Provider Business Practice Location Address
First Line	:	1720 W HORIZON RIDGE PKWY STE 140
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89012-4896
Country	:	US
Telephone Number	:	702-566-5445
Fax Number	:	702-566-5035

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SUNGWOOK S KIM
Credential	:	MD
Telephone Number	:	702-566-5445

Provider Enumeration Date	:	06/11/2007
Last Update Date	:	05/02/2023

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Directions to “S AND S KIM GROUP PC ” Practice Location

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