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General NPI Number Information
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NPI Number | 1033111950
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Entity Type | Individual
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Provider Name | BRIAN YONGTAE KIM D.O.
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Gender | Male
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Dates
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Enumeration Date | 08/11/2005
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Last Update Date | 04/14/2024
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Provider Practice Location Address
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Address Line | 8901 ROCKVILLE PIKE
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City | BETHESDA
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State | MD
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Zip | 20889-2643
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Country | US
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Telephone | 301-219-2776
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 262
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City | FULTON
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State | MD
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Zip | 20759-0262
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Country | US
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Telephone | 410-707-1112
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | H50722
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License Number State | MD
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