Provider Demographics
NPI:1548452220
Name:KIM, SUSIE HUE (MD)
Entity type:Individual
Prefix:
First Name:SUSIE
Middle Name:HUE
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSIE
Other - Middle Name:HUE
Other - Last Name:KNOSKI-KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:146 S MAIN ST STE L-246
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-2861
Mailing Address - Country:US
Mailing Address - Phone:714-306-9230
Mailing Address - Fax:
Practice Address - Street 1:9449 IMPERIAL HWY # C-228
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-2814
Practice Address - Country:US
Practice Address - Phone:562-657-9575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA100946207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine