Healthcare Provider Details

I. General information

NPI: 1134488547
Provider Name (Legal Business Name): KOREAN RESOURCE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2012
Last Update Date: 05/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10176 BALTIMORE NATIONAL PIKE STE 107
ELLICOTT CITY MD
21042-3650
US

IV. Provider business mailing address

3239A CORPORATE CT
ELLICOTT CITY MD
21042-2247
US

V. Phone/Fax

Practice location:
  • Phone: 410-203-1111
  • Fax: 410-203-2685
Mailing address:
  • Phone: 410-818-0900
  • Fax: 410-203-2685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberR134384
License Number StateMD

VIII. Authorized Official

Name: DR. KIM BYENG KIM
Title or Position: CEO/PRESIDENT
Credential: PH.D.
Phone: 410-818-0900