Provider Demographics
NPI:1962011205
Name:LAZARUS PSYCHIATRY LLC
Entity Type:Organization
Organization Name:LAZARUS PSYCHIATRY LLC
Other - Org Name:LAZARUS PSYCHIATRY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAE HOON
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-236-4669
Mailing Address - Street 1:7201 WISCONSIN AVE STE 440
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4851
Mailing Address - Country:US
Mailing Address - Phone:202-236-4669
Mailing Address - Fax:708-879-8208
Practice Address - Street 1:7201 WISCONSIN AVE STE 440
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4851
Practice Address - Country:US
Practice Address - Phone:202-236-4669
Practice Address - Fax:708-879-8208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-22
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty