MEDICARE: HENRY 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	183500000X	Pharmacist	19332	MD
2	183500000X	Pharmacist	0202210523	VA
3	183500000X	Pharmacist	40044	TN
4	183500000X	Pharmacist	040538	NY
5	183500000X	Pharmacist	58095	TX
6	171100000X	Acupuncturist	U02470	MD

General Provider Information

NPI Number	:	1588850341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HENRY KIM

Provider Business Mailing Address
First Line	:	5006 MONTGOMERY RD
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-6719
Country	:	US
Telephone Number	:	516-851-7601
Fax Number	:

Provider Business Practice Location Address
First Line	:	5006 MONTGOMERY RD
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-6719
Country	:	US
Telephone Number	:	516-851-7601
Fax Number	:

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

Provider Enumeration Date	:	09/14/2007
Last Update Date	:	01/17/2018

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Directions to “ HENRY KIM ” Practice Location

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