MEDICARE: MRS. CHUNHUI J KIM RN, BSN, COHN-S

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	163WX0106X	Occupational Health Registered Nurse	R106674	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R106674	OTHER	MD	OCCUPATIONAL HEALTH NURSE

General Provider Information

NPI Number	:	1558351684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHUNHUI J KIM RN, BSN, COHN-S

Provider Business Mailing Address
First Line	:	10290 BURLEIGH COTTAGE LN
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-5806
Country	:	US
Telephone Number	:	410-480-4958
Fax Number	:

Provider Business Practice Location Address
First Line	:	2480 LLEWELLYN AVE
Second Line	:
City	:	FT MEADE
State	:	MD
Zip	:	20755-5800
Country	:	US
Telephone Number	:	301-677-8390
Fax Number	:	301-677-8876

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

Provider Enumeration Date	:	10/28/2005
Last Update Date	:	07/08/2007

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