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NPI Code Detail

MEDICARE: SIR WOO KIM DO

MEDICARE: SIR WOO KIM DO
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1396683413
Entity Type Code : Individual
Provider Name (Legal Business Name) : SIR WOO KIM DO
Provider Business Mailing Address
First Line : 116-502 SINBANG HANSUNG FEELHAUS APT, TONGJEONG 3-RO 68
Second Line : DONGNAM-GU, CHEONAN-SI, CHUNGCHEONGNAM-DO, SOUTH KOREA
City : CHEONAN
State : CHUNGCHEONGNAMDO
Zip : 31204
Country : KR
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2500 METROHEALTH DR
Second Line :
City : CLEVELAND
State : OH
Zip : 44109-1998
Country : US
Telephone Number : 216-778-4486
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2026
Last Update Date : 03/23/2026

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Directions to “ SIR WOO KIM DO” Practice Location

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