1396683413 NPI number — SIR WOO KIM DO

Table of content: SIR WOO KIM DO (NPI 1396683413)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396683413 NPI number — SIR WOO KIM DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIM
Provider First Name:
SIR WOO
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KIM
Provider Other First Name:
SIRWOO
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1396683413
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/23/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
116-502 SINBANG HANSUNG FEELHAUS APT, TONGJEONG 3-RO 68
Provider Second Line Business Mailing Address:
DONGNAM-GU, CHEONAN-SI, CHUNGCHEONGNAM-DO, SOUTH KOREA
Provider Business Mailing Address City Name:
CHEONAN
Provider Business Mailing Address State Name:
CHUNGCHEONGNAMDO
Provider Business Mailing Address Postal Code:
31204
Provider Business Mailing Address Country Code:
KR
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 METROHEALTH DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44109-1998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-778-4486
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/23/2026

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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