Provider Demographics
NPI:1649294695
Name:KIM, BO SOO (MD)
Entity type:Individual
Prefix:DR
First Name:BO
Middle Name:SOO
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 HOPKINS BAYVIEW CIR
Mailing Address - Street 2:RM 4B74
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-6821
Mailing Address - Country:US
Mailing Address - Phone:410-550-0545
Mailing Address - Fax:410-550-2612
Practice Address - Street 1:5501 HOPKINS BAYVIEW CIR
Practice Address - Street 2:RM 4B74
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-6821
Practice Address - Country:US
Practice Address - Phone:410-550-0545
Practice Address - Fax:410-550-2612
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD72738207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease