Organization
LISA M KIM M D INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA M KIM M.D. (OWNER)
(410) 480-5195
Entity
Organization
Contact information
Practice address
3355 ROGERS AVE, ELLICOTT CITY, MD 21043-4105
(410) 480-5195
(410) 480-5197
Mailing address
3355 ROGERS AVE, ELLICOTT CITY, MD 21043-4105
(410) 480-5195
(410) 480-5197
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
D52479
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
346603500
—
MD
Enumeration date
09/29/2010
Last updated
09/29/2010
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