MEDICARE: SEONG G 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	183500000X	Pharmacist	18173	MD

General Provider Information

NPI Number	:	1730487075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEONG G KIM

Provider Business Mailing Address
First Line	:	842 S 5TH AVE
Second Line	:
City	:	DENTON
State	:	MD
Zip	:	21629-1398
Country	:	US
Telephone Number	:	410-479-1771
Fax Number	:

Provider Business Practice Location Address
First Line	:	842 S 5TH AVE
Second Line	:
City	:	DENTON
State	:	MD
Zip	:	21629-1398
Country	:	US
Telephone Number	:	410-479-1771
Fax Number	:

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

Provider Enumeration Date	:	03/10/2011
Last Update Date	:	03/10/2011

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Directions to “ SEONG G KIM ” Practice Location

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