Individual
SUNG SUP KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
036-078576
IL
207RI0011X
Interventional Cardiology Physician
Primary
036078576
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036078576
—
IL
01
—
080066025
RAILROAD MEDICARE PTAN#
—
01
—
31604584
BCBS
IL
01
—
DF8696
RAILROAD MEDICARE PTAN#
—
01
—
K39415
MEDICARE ID
IL
Enumeration date
06/21/2006
Last updated
04/12/2021
Update your record
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