MEDICARE: STEPHANIE KIM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	24265	MD

General Provider Information

NPI Number	:	1245574268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE KIM

Provider Business Mailing Address
First Line	:	8743 PINEY ORCHARD PKWY
Second Line	:	SUITE 105
City	:	ODENTON
State	:	MD
Zip	:	21113-2343
Country	:	US
Telephone Number	:	410-672-6077
Fax Number	:

Provider Business Practice Location Address
First Line	:	8743 PINEY ORCHARD PKWY
Second Line	:	SUITE 105
City	:	ODENTON
State	:	MD
Zip	:	21113-2343
Country	:	US
Telephone Number	:	410-672-6077
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	05/18/2016

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Directions to “ STEPHANIE KIM ” Practice Location

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