Provider Demographics
NPI:1104888940
Name:KIM, MYUN-KI (MD)
Entity type:Individual
Prefix:
First Name:MYUN-KI
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3450 TYLER COURT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-3604
Mailing Address - Country:US
Mailing Address - Phone:410-465-9133
Mailing Address - Fax:410-992-8591
Practice Address - Street 1:6655 SYKESVILLE ROAD
Practice Address - Street 2:SPRINGFIELD HOSPITAL CENTER
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-7966
Practice Address - Country:US
Practice Address - Phone:410-970-7000
Practice Address - Fax:410-970-7024
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD00180512084P0800X
VA01010236002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry