1215012257 NPI number — DR. SUSAN MEEHAE KIM D.C.

Table of content: DR. SUSAN MEEHAE KIM D.C. (NPI 1215012257)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215012257 NPI number — DR. SUSAN MEEHAE KIM D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIM
Provider First Name:
SUSAN
Provider Middle Name:
MEEHAE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KIM-HUANG
Provider Other First Name:
SUSAN
Provider Other Middle Name:
MEEHAE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1215012257
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7590 AUBURN ROAD, SUITE 014
Provider Second Line Business Mailing Address:
ATTN: MED STAFF
Provider Business Mailing Address City Name:
CONCORD TWP
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44077-9176
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-354-1899
Provider Business Mailing Address Fax Number:
440-354-1845

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8655 MARKET ST
Provider Second Line Business Practice Location Address:
INTEGRATIVE MEDICINE 2ND FL
Provider Business Practice Location Address City Name:
MENTOR
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-255-5508
Provider Business Practice Location Address Fax Number:
440-357-4416
Provider Enumeration Date:
10/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2859 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2133364 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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