Provider Demographics
NPI:1215183991
Name:KIM, ALEXANDER Y (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:Y
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:Y
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:174 WATERFRONT STREET
Mailing Address - Street 2:STE 320
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-1162
Mailing Address - Country:US
Mailing Address - Phone:301-276-5670
Mailing Address - Fax:206-401-5919
Practice Address - Street 1:174 WATERFRONT ST STE 320
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-1162
Practice Address - Country:US
Practice Address - Phone:301-276-5670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD0374202085R0204X, 2085R0204X
MDD747102085R0204X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty