MEDICARE: MS. SOLA 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	207RS0012X	Sleep Medicine (Internal Medicine) Physician	015187	SC
2	207RP1001X	Pulmonary Disease Physician	15187	SC
3	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	15187	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508864968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SOLA KIM M.D.

Provider Business Mailing Address
First Line	:	9150 MEDCOM ST
Second Line	:	STE B
City	:	N CHARLESTON
State	:	SC
Zip	:	29406-7108
Country	:	US
Telephone Number	:	843-572-3330
Fax Number	:	843-572-1255

Provider Business Practice Location Address
First Line	:	9150 MEDCOM ST
Second Line	:	STE B
City	:	N CHARLESTON
State	:	SC
Zip	:	29406-7108
Country	:	US
Telephone Number	:	843-572-3330
Fax Number	:	843-572-1255

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

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	10/14/2024

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