Provider Demographics
NPI:1740518521
Name:KIM, LAUREN E
Entity type:Individual
Prefix:
First Name:LAUREN
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 1:400 HASLETT RD
Mailing Address - Street 2:
Mailing Address - City:JOPPA
Mailing Address - State:MD
Mailing Address - Zip Code:21085-4216
Mailing Address - Country:US
Mailing Address - Phone:570-417-1551
Mailing Address - Fax:
Practice Address - Street 1:1812 PULASKI HWY
Practice Address - Street 2:SUITE B
Practice Address - City:EDGEWOOD
Practice Address - State:MD
Practice Address - Zip Code:21040-1697
Practice Address - Country:US
Practice Address - Phone:443-372-5300
Practice Address - Fax:443-372-5810
Is Sole Proprietor?:No
Enumeration Date:2009-12-07
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22927225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist