Active NPI
Sung Bai Kim, M.D.
- Surgery Physician
- Havre de Grace, MD
National Provider Identifier
1770559353
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- D0061707
- Practice address
- 2027 Pulaski Hwy
205
Havre de Grace, MD 21078-2143 - Phone
- (443) 843-6363
- NPI assigned
- Feb 24, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | D0061707 | MD | Primary |
Addresses
Primary practice location
2027 Pulaski Hwy
205
Havre de Grace, MD 21078-2143
Mailing address
2027 Pulaski Hwy
205
Havre de Grace, MD 21078-2143
Phone (443) 843-6363
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 405670100 | Medicaid | MD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D0061707 | MD | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140739200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1355270400000",
"number": "1770559353",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2027 PULASKI HWY",
"address_2": "205",
"city": "HAVRE DE GRACE",
"state": "MD",
"postal_code": "210782143",
"telephone_number": "443-843-6363"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2027 PULASKI HWY",
"address_2": "205",
"city": "HAVRE DE GRACE",
"state": "MD",
"postal_code": "210782143",
"telephone_number": "443-843-6363"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "SUNG",
"middle_name": "BAI",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-24",
"last_updated": "2012-12-12",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "MD",
"license": "D0061707",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "405670100",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Havre de Grace, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.