Provider Demographics
NPI:1063726461
Name:KIM, DAVID EUN (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EUN
Last Name:KIM
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1671
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21501-1671
Mailing Address - Country:US
Mailing Address - Phone:240-964-8568
Mailing Address - Fax:240-964-8336
Practice Address - Street 1:250 FAME AVE STE 202
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-1587
Practice Address - Country:US
Practice Address - Phone:717-632-9263
Practice Address - Fax:717-646-7439
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD458633207R00000X, 207RC0200X, 207RP1001X
PAMT209041207RP1001X
MDD93854207RP1001X, 207RC0200X
MI4301097151208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA527254YUNMMedicare PIN
PA527254YEBKMedicare PIN