Provider Demographics
NPI:1275502163
Name:UM, NARA KYUNGSUN (MD)
Entity Type:Individual
Prefix:DR
First Name:NARA
Middle Name:KYUNGSUN
Last Name:UM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4725 DORSEY HALL DR STE A402
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-7926
Mailing Address - Country:US
Mailing Address - Phone:202-710-6512
Mailing Address - Fax:
Practice Address - Street 1:4725 DORSEY HALL DR STE A402
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7926
Practice Address - Country:US
Practice Address - Phone:202-710-6512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4386702083C0008X, 207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083C0008XAllopathic & Osteopathic PhysiciansPreventive MedicineClinical Informatics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA188926JJFMedicare PIN
I38790Medicare UPIN