MEDICARE: DR. BRYAN SUNGKOO KHIM 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	207Q00000X	Family Medicine Physician	D50978	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	04720930647	OTHER		MEDICAL EDUCATION NO.

General Provider Information

NPI Number	:	1598788762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYAN SUNGKOO KHIM M.D.

Provider Business Mailing Address
First Line	:	8815 BALTIMORE NATIONAL PIKE
Second Line	:	SUITE B
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-4111
Country	:	US
Telephone Number	:	410-480-1800
Fax Number	:	410-480-2899

Provider Business Practice Location Address
First Line	:	8815 BALTIMORE NATIONAL PIKE
Second Line	:	SUITE B
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-4111
Country	:	US
Telephone Number	:	410-480-1800
Fax Number	:	410-480-2899

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	10/14/2014

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