Organization
MYUNG-SUP KIM MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MYUNG-SUP KIM MD (PRESIDENT)
(301) 724-1646
Entity
Organization
Contact information
Practice address
RT 55 WEST, PETERSBURG, WV 26847
(304) 257-1026
Mailing address
PO BOX 240, CUMBERLAND, MD 21501-0240
(301) 724-1646
(301) 724-7429
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001708869
BLUE SHIELD
WV
01
—
02059300
BLACK LUNG
—
01
—
1120362
MAMSI
—
05
—
3810011406
—
WV
05
—
991702100
—
MD
01
—
KCD4
BLUE SHIELD
MD
01
—
S366
FEDERAL BS
MD
Enumeration date
03/23/2006
Last updated
08/16/2010
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