KWANGSUP S KIM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****72

License Status

NOT RENEWED

Business

First Name

KWANGSUP S

Last Name

KIM

Suffix

Business Name

KWANGSUP S KIM MD

Original Issue Date

01/20/2000

Effective Date

01/20/2000

Expiration Date

07/31/2002

City

GODFREY

State

Zip

62035

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006