Individual
SUCKHONG BRIAN KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1540 E EVERGREEN ST, SPRINGFIELD, MO 65803-4300
(417) 823-2900
(417) 886-2774
Mailing address
1540 E EVERGREEN ST, SPRINGFIELD, MO 65803-4300
(417) 823-2900
(417) 886-2774
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
R5J91
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
039014838
—
MO
01
—
107067
BLUE CROSS/BLUE SHIELD
—
05
—
188306001
—
AR
05
—
1922041839
—
MO
05
—
202657011
—
MO
01
—
P00361138
RR MEDICARE
—
01
—
P00958203
RR MEDICARE
AR
Enumeration date
06/14/2006
Last updated
04/09/2024
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