MEDICARE: DR. BRIAN C KOK PHD

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	103TC0700X	Clinical Psychologist	06305	MD

General Provider Information

NPI Number	:	1548871536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN C KOK PHD

Provider Business Mailing Address
First Line	:	10440 SHAKER DR STE 203
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21046-2346
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10440 SHAKER DR STE 203
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21046-2346
Country	:	US
Telephone Number	:	443-681-9204
Fax Number	:

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

Provider Enumeration Date	:	08/12/2020
Last Update Date	:	08/12/2020

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