Soon Ja Kim Md Pa | |
5808 Main St Elkridge MD 21075-5105 | |
(410) 796-7730 | |
(410) 379-1537 |
Full Name | Soon Ja Kim Md Pa |
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Speciality | Family Medicine |
Location | 5808 Main St, Elkridge, Maryland |
Authorized Official Name and Position | Soon Ja Kim (PRESIDENT) |
Authorized Official Contact | 4107967730 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Soon Ja Kim Md Pa 5808 Main St Elkridge MD 21075-5105 Ph: (410) 796-7730 | Soon Ja Kim Md Pa 5808 Main St Elkridge MD 21075-5105 Ph: (410) 796-7730 |
NPI Number | 1669796710 |
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Provider Enumeration Date | 03/18/2010 |
Last Update Date | 04/21/2010 |
Medicare PECOS PAC ID | 0042346280 |
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Medicare Enrollment ID | O20100327000008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1669796710 | NPI | - | NPPES |
794391100 | Medicaid | MD | |
010003063 | Other | MD | MEDICARE RAILROAD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207QA0505X | Family Medicine - Adult Medicine | (* (Not Available)) | Primary |
Provider Name | Soon Kim |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1023095643 PECOS PAC ID: 8224164462 Enrollment ID: I20100327000006 |
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