Provider Demographics
NPI:1336731264
Name:KIM, KYUNG E
Entity Type:Individual
Prefix:
First Name:KYUNG
Middle Name:E
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:ARBUTUS
Mailing Address - State:MD
Mailing Address - Zip Code:21227-1627
Mailing Address - Country:US
Mailing Address - Phone:410-737-7712
Mailing Address - Fax:410-737-7715
Practice Address - Street 1:3601 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:ARBUTUS
Practice Address - State:MD
Practice Address - Zip Code:21227-1627
Practice Address - Country:US
Practice Address - Phone:410-737-7712
Practice Address - Fax:410-737-7715
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18469183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist