Provider Demographics
NPI:1811000565
Name:ODIM, JONAH NK (MD, PHD)
Entity type:Individual
Prefix:
First Name:JONAH
Middle Name:NK
Last Name:ODIM
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9801 TRAVILLE COMMONS DR
Mailing Address - Street 2:THE JNKO GROUP, LLC SUITE 302
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-7493
Mailing Address - Country:US
Mailing Address - Phone:301-340-2823
Mailing Address - Fax:
Practice Address - Street 1:9801 TRAVILLE COMMONS DR
Practice Address - Street 2:THE JNKO GROUP, LLC SUITE 302
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-7493
Practice Address - Country:US
Practice Address - Phone:301-340-2823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83772208G00000X
MDD0065408207RC0200X, 2086S0102X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Not Answered207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Not Answered2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G837720OtherMEDICAL PPIN #
CAE56468Medicare UPIN
CAWG83772AMedicare ID - Type UnspecifiedPPIN #