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NPI Code Detail

MEDICARE: HAE SOOK KIM DMD LLC

MEDICARE: HAE SOOK KIM DMD LLC
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
1122300000XDentist13931MD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1538557533
Entity Type Code : Organization
Provider Name (Legal Business Name) : HAE SOOK KIM DMD LLC
Provider Business Mailing Address
First Line : 29795 THREE NOTCH RD
Second Line :
City : CHARLOTTE HALL
State : MD
Zip : 20622-4106
Country : US
Telephone Number : 301-290-0001
Fax Number : 301-290-5633
Provider Business Practice Location Address
First Line : 29795 THREE NOTCH RD
Second Line :
City : CHARLOTTE HALL
State : MD
Zip : 20622-4106
Country : US
Telephone Number : 301-290-0001
Fax Number : 301-290-5633
Authorized Official
Title or Position : OWNER
Name : DR. HAE SOOK KIM
Credential : DMD
Telephone Number : 301-290-0001
Provider Enumeration Date : 12/30/2014
Last Update Date : 12/30/2014

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Directions to “HAE SOOK KIM DMD LLC ” Practice Location

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