Healthcare Provider Details

I. General information

NPI: 1265062988
Provider Name (Legal Business Name): BARBARA KIM, M.D., L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2020
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 KENILWORTH DR STE 100
TOWSON MD
21204-2142
US

IV. Provider business mailing address

6240 PLAITED REED
COLUMBIA MD
21044-3712
US

V. Phone/Fax

Practice location:
  • Phone: 410-881-3917
  • Fax: 410-881-3917
Mailing address:
  • Phone: 410-881-3917
  • Fax: 410-881-3917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BARBARA ANN KIM
Title or Position: PSYCHIATRIST
Credential: MD
Phone: 410-881-3917