Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | H-50722 | MD |
Y | 213ES0000X | Sports Medicine | H-50722 | MD |
NPI | 1033111950 |
---|---|
Provider Name | Dr. Brian Yongtae Kim |
First Address | Germantown, MD 20874-2643 |
Second Address | Germantown, MD 20874-2643 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2005 |
Last Update Date | 08/07/2007 |