1659301992 NPI number — SUNNY S. KIM, MD PA

Table of content: (NPI 1659301992)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659301992 NPI number — SUNNY S. KIM, MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNNY S. KIM, MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1659301992
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1601 HIGHWAY 13 E STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURNSVILLE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55337-6847
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-405-9760
Provider Business Mailing Address Fax Number:
855-430-6952

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 HIGHWAY 13 E STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURNSVILLE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55337-6847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-763-8888
Provider Business Practice Location Address Fax Number:
952-405-9760
Provider Enumeration Date:
07/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NAVARRETE
Authorized Official First Name:
NICOLE
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS OPERATIONS MANAGER
Authorized Official Telephone Number:
651-456-8795

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , with the licence number:  54789 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0117X , with the licence number: 31927 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6727410001 . This is a "NSC" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 250003199 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 963393600 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20011924 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 178083200 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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