Provider Demographics
NPI:1275633075
Name:KIM, HEI-JUNG C (MD)
Entity Type:Individual
Prefix:DR
First Name:HEI-JUNG
Middle Name:C
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14804 PHYSICIANS LANE
Mailing Address - Street 2:SUITE 122
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3912
Mailing Address - Country:US
Mailing Address - Phone:301-424-7700
Mailing Address - Fax:301-424-0305
Practice Address - Street 1:14804 PHYSICIANS LANE
Practice Address - Street 2:SUITE 122
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3912
Practice Address - Country:US
Practice Address - Phone:301-424-7700
Practice Address - Fax:301-424-0305
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD328682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD718500600Medicaid
107046ZFGVOtherMEDICARE ID
MD766002200Medicaid
MD718500600Medicaid