Provider Demographics
NPI:1801803101
Name:KIM, DAVID D (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:D
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1111 BENFIELD BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108
Mailing Address - Country:US
Mailing Address - Phone:410-729-5100
Mailing Address - Fax:410-729-5156
Practice Address - Street 1:11055 LITTLE PATUXENT PARKWAY
Practice Address - Street 2:SUITE 205
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044
Practice Address - Country:US
Practice Address - Phone:410-740-0789
Practice Address - Fax:410-740-7024
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2012-09-07
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Provider Licenses
StateLicense IDTaxonomies
NY237369207R00000X
MDD66910207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD414745600Medicaid
MD414745600Medicaid
MDP00656540Medicare PIN