Provider Demographics
NPI:1720309271
Name:KIM, MYUNGJIN GLORIA (MD)
Entity Type:Individual
Prefix:
First Name:MYUNGJIN
Middle Name:GLORIA
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 1:8901 ROCKVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889-0001
Mailing Address - Country:US
Mailing Address - Phone:301-295-4331
Mailing Address - Fax:
Practice Address - Street 1:8901 ROCKVILLE PIKE NEPHROLOGY
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-5001
Practice Address - Country:US
Practice Address - Phone:301-295-4331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-18
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101250723207R00000X, 207RN0300X, 390200000X, 246ZN0300X
246ZN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZN0300XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program