Healthcare Provider Details

I. General information

NPI: 1881520658
Provider Name (Legal Business Name): MY PRIMARY CARE NP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2014 S TOLLGATE RD STE 200-201
BEL AIR MD
21015-5903
US

IV. Provider business mailing address

2014 S TOLLGATE RD STE 200-201
BEL AIR MD
21015-5903
US

V. Phone/Fax

Practice location:
  • Phone: 410-999-7397
  • Fax:
Mailing address:
  • Phone: 410-999-7397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. LANA EUN-CHO KIM
Title or Position: DNP/OWNER
Credential: DNP, CRNP
Phone: 410-999-7397