Provider Demographics
NPI:1407244478
Name:KIM, KYUNG HEE (MS, CNS, LDN)
Entity Type:Individual
Prefix:
First Name:KYUNG HEE
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MS, CNS, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 SALEM LN NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-1920
Mailing Address - Country:US
Mailing Address - Phone:202-321-2801
Mailing Address - Fax:
Practice Address - Street 1:4525 SALEM LN NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-1920
Practice Address - Country:US
Practice Address - Phone:202-321-2801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-29
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX3658133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist