Provider Demographics
NPI:1720077514
Name:KIM, EMERY L (MD)
Entity Type:Individual
Prefix:
First Name:EMERY
Middle Name:L
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 1:1447 YORK RD
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6017
Mailing Address - Country:US
Mailing Address - Phone:410-339-5529
Mailing Address - Fax:410-339-5530
Practice Address - Street 1:144 7 YORK RD
Practice Address - Street 2:STE 100
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093
Practice Address - Country:US
Practice Address - Phone:410-339-5529
Practice Address - Fax:410-339-5530
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD62403207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD407506400Medicaid
I 23810Medicare UPIN
MD407506400Medicaid