Individual
MR. SUN KUK KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4000 COAST GUARD BLVD, PORTSMOUTH, VA 23703-2135
(757) 483-8596
(757) 483-8610
Mailing address
4000 COAST GUARD BLVD, PORTSMOUTH, VA 23703-2135
(577) 483-8596
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1123015
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1123015
NCCPA
—
01
—
25MP00362400
STATE LICENSE
NJ
Enumeration date
08/06/2007
Last updated
03/07/2023
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