Provider Demographics
NPI:1760114532
Name:KUM, EUI SOP (LAC)
Entity Type:Individual
Prefix:MR
First Name:EUI SOP
Middle Name:
Last Name:KUM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 CORPORATE CT STE D
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-2273
Mailing Address - Country:US
Mailing Address - Phone:410-418-4888
Mailing Address - Fax:410-418-4020
Practice Address - Street 1:3240 CORPORATE CT STE D
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-2273
Practice Address - Country:US
Practice Address - Phone:410-418-4888
Practice Address - Fax:410-418-4020
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02866171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist