Provider Demographics
NPI:1871798900
Name:KIM, SUNGWOOK S (MD)
Entity type:Individual
Prefix:
First Name:SUNGWOOK
Middle Name:S
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 1:1450 W HORIZON RIDGE PKWY STE B304 # 570
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-4480
Mailing Address - Country:US
Mailing Address - Phone:702-566-5445
Mailing Address - Fax:702-566-5035
Practice Address - Street 1:1720 W HORIZON RIDGE PKWY STE 140
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-4896
Practice Address - Country:US
Practice Address - Phone:702-566-5445
Practice Address - Fax:702-566-5035
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12166207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100512770Medicaid
NV100512770Medicaid