Provider Demographics
NPI:1407043466
Name:JIKI MEDICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:JIKI MEDICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JI YON
Authorized Official - Middle Name:
Authorized Official - Last Name:HWANG-KI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-610-6630
Mailing Address - Street 1:14804 PHYSICIANS LN
Mailing Address - Street 2:SUITE 121
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3941
Mailing Address - Country:US
Mailing Address - Phone:301-610-6630
Mailing Address - Fax:
Practice Address - Street 1:14804 PHYSICIANS LN
Practice Address - Street 2:SUITE 121
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3941
Practice Address - Country:US
Practice Address - Phone:301-610-6630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMDD 66159261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care