Individual
DR. LISA M KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
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
207R00000X
Internal Medicine Physician
Primary
D0052479
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
141887661
TAX ID
MD
05
—
346603500
—
MD
Enumeration date
09/27/2006
Last updated
03/07/2023
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