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General NPI Number Information
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NPI Number | 1548582877
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Entity Type | Organization
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Legal Business Name | ALT. MEDICINE INC.
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Dates
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Enumeration Date | 03/01/2010
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Last Update Date | 03/01/2010
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Provider Practice Location Address
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Address Line | 3201 CORPORATE CT FL 1
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City | ELLICOTT CITY
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State | MD
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Zip | 21042-2247
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Country | US
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Telephone | 410-203-1597
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Fax |
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Provider Business Mailing Address
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Address Line | 3201 CORPORATE CT FL 1
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City | ELLICOTT CITY
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State | MD
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Zip | 21042-2247
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Country | US
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Telephone | 410-203-1597
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JUNG SOP KIM
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Credential | D.O.M.
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Telephone | 410-203-1597
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | U01789
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License Number State | MD
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