Individual
KYUNG SOO KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
14049 E 13 MILE RD STE 1, WARREN, MI 48088-5876
(586) 415-0103
(586) 415-0108
Mailing address
49050 SCHOENHERR RD STE 100, SHELBY TWP, MI 48315-3848
(586) 566-7870
(586) 566-7850
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
4301032265
MI
207UN0901X
Nuclear Cardiology Physician
4301032265
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060-507-4551
BLUECROSSBLUESHIELD
MI
01
—
OH-26467002
MEDICARE ID
MI
Enumeration date
08/12/2005
Last updated
03/07/2023
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