Organization
WESTERN MD PET IMAGING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONG K KIM M.D. (PRESIDENT)
(301) 724-1646
Entity
Organization
Contact information
Practice address
952 SETON DR, CUMBERLAND, MD 21502-1950
(301) 777-3522
(301) 777-1902
Mailing address
PO BOX 808, CUMBERLAND, MD 21501-0808
(301) 724-1646
(301) 724-7429
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0208472000
—
WV
01
—
217A
MD BLUE SHIELD
MD
01
—
DB6053
RAILROAD MEDICARE
—
01
—
J248
MD BLUE SHIELD
MD
Enumeration date
05/23/2005
Last updated
07/25/2007
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