Provider Demographics
NPI:1841963956
Name:KIM, BENJAMIN (DNP)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 N FREDERICK AVE # 1490
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-2504
Mailing Address - Country:US
Mailing Address - Phone:301-948-3250
Mailing Address - Fax:
Practice Address - Street 1:546 N FREDERICK AVE # 1490
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2504
Practice Address - Country:US
Practice Address - Phone:301-948-3250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR214964363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily