Provider Demographics
NPI:1912250580
Name:HEI-JUNG C KIM M.D. L.L.C.
Entity Type:Organization
Organization Name:HEI-JUNG C KIM M.D. L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEI-JUNG
Authorized Official - Middle Name:C
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-424-7700
Mailing Address - Street 1:14804 PHYSICIANS LN STE 122
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3912
Mailing Address - Country:US
Mailing Address - Phone:301-424-7700
Mailing Address - Fax:301-424-0305
Practice Address - Street 1:14804 PHYSICIANS LN STE 122
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3912
Practice Address - Country:US
Practice Address - Phone:301-424-7700
Practice Address - Fax:301-424-0305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD112201041C0700X
MD099791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD404107100Medicaid
MD483700200Medicaid