Individual
MR. JAE HOON KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNP-PMH
Contact information
Practice address
7201 WISCONSIN AVE STE 440, BETHESDA, MD 20814-4851
(202) 236-4669
Mailing address
7201 WISCONSIN AVE STE 440, BETHESDA, MD 20814-4851
(202) 236-4669
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
0024178821
VA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R189134
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30015955680008
—
VA
05
—
587108500
—
MD
05
—
822275
—
MD
Enumeration date
11/19/2012
Last updated
06/08/2024
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