1598282469 NPI number — DR. MINSU KIM PHD

Table of content: DR. MINSU KIM PHD (NPI 1598282469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598282469 NPI number — DR. MINSU KIM PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIM
Provider First Name:
MINSU
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598282469
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16, JUKBAEK 4-RO
Provider Second Line Business Mailing Address:
SOSABEUL THE SHARP MASTERVIEW, 101-DONG 2504-HO
Provider Business Mailing Address City Name:
PYEONGTAEK-SI
Provider Business Mailing Address State Name:
GYEONGGI-DO
Provider Business Mailing Address Postal Code:
17863
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:
SHINJANG-DONG 325-70
Provider Second Line Business Practice Location Address:
MIRAE TOWER, 2ND FLOOR, INTEGRATED COUNSELING SERVICES
Provider Business Practice Location Address City Name:
PYEONGTAEK
Provider Business Practice Location Address State Name:
GYEONGGI-DO
Provider Business Practice Location Address Postal Code:
17758
Provider Business Practice Location Address Country Code:
KR
Provider Business Practice Location Address Telephone Number:
31-662-7571
Provider Business Practice Location Address Fax Number:
31-662-7572
Provider Enumeration Date:
08/23/2017

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: 103T00000X , with the licence number:  06726 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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