Provider Demographics
NPI:1700608338
Name:SHIN, KUM HO (ACUPUNCTURIST)
Entity type:Individual
Prefix:
First Name:KUM
Middle Name:HO
Last Name:SHIN
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7577 WARBURG WAY
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-2397
Mailing Address - Country:US
Mailing Address - Phone:201-280-6463
Mailing Address - Fax:
Practice Address - Street 1:7577 WARBURG WAY
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-2397
Practice Address - Country:US
Practice Address - Phone:201-280-6463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02892171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist