Provider Demographics
NPI:1275538845
Name:KIM, THEODORE Y (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:Y
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:12510 PROSPERITY DR
Mailing Address - Street 2:STE 200
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1663
Mailing Address - Country:US
Mailing Address - Phone:240-485-5200
Mailing Address - Fax:301-625-6906
Practice Address - Street 1:7350 VAN DUSEN RD
Practice Address - Street 2:STE 210
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5268
Practice Address - Country:US
Practice Address - Phone:301-498-5500
Practice Address - Fax:301-498-7346
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2016-07-08
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Provider Licenses
StateLicense IDTaxonomies
MDD0033979207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00679066OtherRAILROAD MEDICARE
MD531224-01OtherCAREFIRST BSMD
MDN5630029OtherCAREFIRST DC/MD
DCA1110003OtherCAREFIRST BCBS DC
DCA1130004OtherCAREFIRST BCBS DC
MD275761300Medicaid
DC2516-0002OtherCAREFIRST BSDC
MD10040326OtherRAILROAD MEDICARE
MDN5630029OtherCAREFIRST DC/MD
MDE53250Medicare UPIN
MDP00679066OtherRAILROAD MEDICARE
MD135992Medicare PIN