Provider Demographics
NPI:1700961000
Name:KIM, SUN JIN (MD)
Entity type:Individual
Prefix:
First Name:SUN JIN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 W 42ND ST
Mailing Address - Street 2:APT 32D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-1920
Mailing Address - Country:US
Mailing Address - Phone:917-658-9964
Mailing Address - Fax:
Practice Address - Street 1:1250 WATERS PLACE, 11TH FLOOR
Practice Address - Street 2:MMC - ORTHOPEDIC SURGERY
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:347-577-4599
Practice Address - Fax:347-577-4473
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY232632207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery