Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | D0018799 | MD |
NPI | 1043377823 |
---|---|
Provider Name | Dr. Byung-Oh Kim |
First Address | Columbia, MD 21044-3800 |
Second Address | Ellicott City, MD 21042-7711 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D71990 | (02) | MD |