MEDICARE: DR. JUNG AH KIM

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	171100000X	Acupuncturist	U02330	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	U02330	OTHER	MD	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1710339601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUNG AH KIM

Provider Business Mailing Address
First Line	:	9455 BALTIMORE NATIONAL PIKE STE B
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-2812
Country	:	US
Telephone Number	:	443-535-7575
Fax Number	:

Provider Business Practice Location Address
First Line	:	9455 BALTIMORE NATIONAL PIKE STE B
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-2812
Country	:	US
Telephone Number	:	443-535-7575
Fax Number	:

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

Provider Enumeration Date	:	07/05/2016
Last Update Date	:	05/14/2021

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