Healthcare Provider Details

I. General information

NPI: 1952218869
Provider Name (Legal Business Name): KIM MEDICAL OF NEW YORK PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 LIGHTHOUSE POINT E #220
BALTIMORE MD
21224
US

IV. Provider business mailing address

1443 ROCK SPRING RD UNIT 340
BEL AIR MD
21014-1920
US

V. Phone/Fax

Practice location:
  • Phone: 516-687-9444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID KIM
Title or Position: MANAGING MEMBER
Credential:
Phone: 516-252-3939