Provider Demographics
NPI:1447665369
Name:KIM, SUNG HYUN (MD)
Entity type:Individual
Prefix:
First Name:SUNG HYUN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3747 OAK GLEN DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-3751
Mailing Address - Country:US
Mailing Address - Phone:714-562-9139
Mailing Address - Fax:213-769-0007
Practice Address - Street 1:7011 ORANGETHORPE AVE STE 100
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-3322
Practice Address - Country:US
Practice Address - Phone:714-562-9139
Practice Address - Fax:213-769-0007
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA153045207R00000X
GA77160207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program