Kim, Jae Suk

Kim, Jae Suk is an individual health care provider with primary practice located at 24025 Greater Mack Suite 103, St Clair Shores MI 48080. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Kim, Jae Suk can be contacted via phone (586) 777-8280.

Contact Information

Primary practice address
24025 Greater Mack Suite 103 St Clair Shores MI 48080
Phone: (586) 777-8280
Fax: (586) 777-8688
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 4301033045 Michigan

Profile Details

NPI number 1790899755
LBN Legal business name Kim, Jae Suk
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 18th, 2006
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790899755 NPPES
Michigan MEDICAID 1947637

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