Mike Sunwoo Kim, DO

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

91050 Issued in GA

Practice address

301 Fisher St RM 1G123
Keesler AFB, MS 39534-2519

Phone

(228) 376-0577

Fax

(228) 376-0103

NPI assigned

Jun 16, 2019

Last updated

Jun 28, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1560643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687910400000",
    "number": "1568022242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 FISHER ST RM 1G123",
            "city": "KEESLER AFB",
            "state": "MS",
            "postal_code": "395342519",
            "telephone_number": "282-376-0577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 FISHER ST RM 1G123",
            "city": "KEESLER AFB",
            "state": "MS",
            "postal_code": "395342519",
            "telephone_number": "228-376-0577",
            "fax_number": "228-376-0103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "MIKE",
        "middle_name": "SUNWOO",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-16",
        "last_updated": "2023-06-28",
        "certification_date": "2023-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "91050",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tabitha M Kabala, D.O.
• Brian Anthony Katen, PT
• Gregory Shayne Katirgis, PHARM. D
• Keesler Medical Center 81St Medical Group
• Emanuel Alexander Keiler, MD
• Bristal Lea Kinderman, COA
• Steven M Kindsvater, M.D.
• Cody B King, MD
• Bailey Kleis
• Scott Matthew Klem, DO

• Internal Medicine Physician in Keesler AFB, MS
• Providers in Keesler AFB, MS by specialty
• Internal Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.