| NPI | 1366825325 |
|---|---|
| Former Name | SU MI KIM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA OA003573) |
| 363AM0700X Physician Assistant, Medical (Licence: PA MA057669) | |
| Enumeration Date | 2015-07-08 |
| Last Update Date | 2019-12-05 |