Provider Demographics
NPI:1417732546
Name:KIM, YOUNG JUN (FNP)
Entity Type:Individual
Prefix:
First Name:YOUNG
Middle Name:JUN
Last Name:KIM
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8840 PAPILLON DR
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-4000
Mailing Address - Country:US
Mailing Address - Phone:443-718-1037
Mailing Address - Fax:
Practice Address - Street 1:804 LANDMARK DR STE 118
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4486
Practice Address - Country:US
Practice Address - Phone:410-863-4899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR233728363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily