Healthcare Provider Details

I. General information

NPI: 1982607933
Provider Name (Legal Business Name): ADR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 08/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

952 SETON DR
CUMBERLAND MD
21502-1950
US

IV. Provider business mailing address

PO BOX 808
CUMBERLAND MD
21501-0808
US

V. Phone/Fax

Practice location:
  • Phone: 301-777-3522
  • Fax: 301-777-1902
Mailing address:
  • Phone: 301-724-1646
  • Fax: 301-724-7429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. JONG K KIM
Title or Position: PRESIDENT
Credential: MD
Phone: 301-724-1646