Provider Demographics
NPI:1548434236
Name:KIM, SANG W (MD)
Entity type:Individual
Prefix:
First Name:SANG
Middle Name:W
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4939 BRITTONFIELD PKWY
Mailing Address - Street 2:BUILDING B, SUITE 210
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-9208
Mailing Address - Country:US
Mailing Address - Phone:315-471-8404
Mailing Address - Fax:315-471-6803
Practice Address - Street 1:4939 BRITTONFIELD PKWY
Practice Address - Street 2:BUILDING B, SUITE 210
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9208
Practice Address - Country:US
Practice Address - Phone:315-471-8404
Practice Address - Fax:315-471-6803
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2014-08-26
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Provider Licenses
StateLicense IDTaxonomies
390200000X
NY273922207YX0007X, 207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03855896Medicaid
NYJ400151290Medicare PIN