Healthcare Provider Details

I. General information

NPI: 1912842287
Provider Name (Legal Business Name): HOLLY N KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S CATON AVE
FULTON MD
21229
US

IV. Provider business mailing address

11345 MARKET STREET
FULTON MD
20759
US

V. Phone/Fax

Practice location:
  • Phone: 410-707-8946
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR184801
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: