Active NPI
Kevin Minkyo Kim, DPT
- Physical Therapist
- Baltimore, MD
National Provider Identifier
1679081673
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 26857
- Practice address
- 3455 Wilkens Ave Ste 306
Baltimore, MD 21229-5214 - Phone
- (410) 737-8418
- NPI assigned
- Jan 12, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 26857 | MD | Primary |
Addresses
Primary practice location
3455 Wilkens Ave Ste 306
Baltimore, MD 21229-5214
Mailing address
9702 Early Spring Way
Columbia, MD 21046-2054
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26857 | MD | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1515715200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1708473600000",
"number": "1679081673",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9702 EARLY SPRING WAY",
"city": "COLUMBIA",
"state": "MD",
"postal_code": "210462054"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3455 WILKENS AVE STE 306",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212295214",
"telephone_number": "410-737-8418"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "KEVIN",
"middle_name": "MINKYO",
"credential": "DPT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-01-12",
"last_updated": "2024-02-21",
"certification_date": "2024-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MD",
"license": "26857",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.