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1306849492

NPI Code Detail

MEDICARE: DR. MYUNG-SUP KIM M.D.

MEDICARE: DR. MYUNG-SUP KIM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	D26261	MD
2	2085B0100X	Body Imaging Physician	D26261	MD
3	2085D0003X	Diagnostic Neuroimaging (Radiology) Physician	D26261	MD
4	2085N0700X	Neuroradiology Physician	D26261	MD
5	2085N0904X	Nuclear Radiology Physician	D26261	MD
6	2085R0204X	Vascular & Interventional Radiology Physician	D26261	MD
7	2085U0001X	Diagnostic Ultrasound Physician	D26261	MD
8	2085R0202X	Diagnostic Radiology Physician	D26261	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	J2480003	OTHER	MD	GHMSI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	S3660001	OTHER	MD	GHMSI
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	001708869	OTHER	WV	MT ST BLUE SHIELD
8	J2490003	OTHER	MD	GHMSI

General Provider Information

NPI Number	:	1306849492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MYUNG-SUP KIM M.D.

Provider Business Mailing Address
First Line	:	PO BOX 808
Second Line	:
City	:	CUMBERLAND
State	:	MD
Zip	:	21501-0808
Country	:	US
Telephone Number	:	301-724-1646
Fax Number	:	301-724-7429

Provider Business Practice Location Address
First Line	:	952 SETON DR
Second Line	:
City	:	CUMBERLAND
State	:	MD
Zip	:	21502-1950
Country	:	US
Telephone Number	:	301-777-3522
Fax Number	:	301-777-1902

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	10/20/2021

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Directions to “ DR. MYUNG-SUP KIM M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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