Individual
SEUNG SOO KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11109 PARKVIEW PLAZA DR, FORT WAYNE, IN 46845-1701
(260) 266-1000
Mailing address
2458 LAKE AVE, FORT WAYNE, IN 46805-5406
(260) 424-2195
(260) 422-0077
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
01040258A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100364240
—
IN
Enumeration date
11/29/2005
Last updated
08/21/2018
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