MEDICARE: HAEDONG KIM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	LGM542	MD
2	106H00000X	Marriage & Family Therapist	LCM1197	MD
3	106H00000X	Marriage & Family Therapist	0717002646	VA

General Provider Information

NPI Number	:	1033823026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAEDONG KIM

Provider Business Mailing Address
First Line	:	8000 YORK RD, COLLEGE OF LIBERAL ARTS, RM. 2234
Second Line	:	DEPT. OF FAMILY STUDIES & COMMUNITY DEVELOPMENT
City	:	TOWSON
State	:	MD
Zip	:	21252
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6931 ARLINGTON RD STE 440
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20814-5231
Country	:	US
Telephone Number	:	240-424-5328
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2023
Last Update Date	:	04/17/2026

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Directions to “ HAEDONG KIM ” Practice Location

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