Provider Demographics
NPI:1003346404
Name:KL GORING LLC
Entity Type:Organization
Organization Name:KL GORING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:LESLEY
Authorized Official - Last Name:GORING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-223-7308
Mailing Address - Street 1:9962 CYPRESS WAY
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-6021
Mailing Address - Country:US
Mailing Address - Phone:240-223-7308
Mailing Address - Fax:
Practice Address - Street 1:995 PRINCE FREDERICK BLVD STE 101
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-3199
Practice Address - Country:US
Practice Address - Phone:410-414-6550
Practice Address - Fax:443-968-9205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-18
Last Update Date:2017-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD56571207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1265404883Medicaid