Provider Demographics
NPI:1598974214
Name:KIM, TAO (NP)
Entity Type:Individual
Prefix:
First Name:TAO
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7701 GREENBELT RD
Mailing Address - Street 2:STE 504
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-6525
Mailing Address - Country:US
Mailing Address - Phone:301-345-7375
Mailing Address - Fax:301-345-7269
Practice Address - Street 1:7701 GREENBELT RD
Practice Address - Street 2:SUITE 504
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2037
Practice Address - Country:US
Practice Address - Phone:301-345-7375
Practice Address - Fax:301-345-7269
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR149755363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP34883Medicare UPIN