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General NPI Number Information
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NPI Number | 1194538918
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Entity Type | Organization
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Legal Business Name | KIM PODIATRY LLC
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Dates
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Enumeration Date | 01/27/2025
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Last Update Date | 08/11/2025
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Provider Practice Location Address
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Address Line | 4701 RANDOLPH RD STE 103
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City | ROCKVILLE
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State | MD
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Zip | 20852-2260
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Country | US
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Telephone | 216-217-9322
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Fax |
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Provider Business Mailing Address
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Address Line | 4701 RANDOLPH RD STE 103
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City | ROCKVILLE
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State | MD
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Zip | 20852-2260
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Country | US
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Telephone | 240-206-6274
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHANG YONG KIM
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Credential | DPM
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Telephone | 240-206-6274
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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