Provider Demographics
NPI:1548582877
Name:ALT. MEDICINE INC.
Entity Type:Organization
Organization Name:ALT. MEDICINE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUNG
Authorized Official - Middle Name:SOP
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:410-203-1597
Mailing Address - Street 1:3201 CORPORATE CT FL 1
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-2247
Mailing Address - Country:US
Mailing Address - Phone:410-203-1597
Mailing Address - Fax:
Practice Address - Street 1:3201 CORPORATE CT FL 1
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-2247
Practice Address - Country:US
Practice Address - Phone:410-203-1597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01789261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1255662896Medicare PIN