Provider Demographics
NPI:1164307864
Name:KIM, DEOKHO (DIPL AC)
Entity type:Individual
Prefix:DR
First Name:DEOKHO
Middle Name:
Last Name:KIM
Suffix:
Gender:X
Credentials:DIPL AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10773 FOLKESTONE WAY
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:MD
Mailing Address - Zip Code:21163-1313
Mailing Address - Country:US
Mailing Address - Phone:215-272-8523
Mailing Address - Fax:
Practice Address - Street 1:935 RUSSELL AVE STE B
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3291
Practice Address - Country:US
Practice Address - Phone:215-272-8523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU03230171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist