Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 16712 | MD |
NPI | 1043656655 |
---|---|
Provider Name | Scott Seung Young Kim |
First Address | College Park, MD 20740-2358 |
Second Address | Laurel, MD 20708-1179 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2013 |
Last Update Date | 27/05/2021 |