MEDICARE: DR. JEAN KIM M.D.

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	2084P0800X	Psychiatry Physician	D70748	MD

General Provider Information

NPI Number	:	1659333466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEAN KIM M.D.

Provider Business Mailing Address
First Line	:	10903 NEW HAMPSHIRE AVE
Second Line	:	FOOD AND DRUG ADMINISTRATION (FDA)
City	:	SILVER SPRING
State	:	MD
Zip	:	20903-1058
Country	:	US
Telephone Number	:	240-402-0034
Fax Number	:

Provider Business Practice Location Address
First Line	:	10903 NEW HAMPSHIRE AVE
Second Line	:	FOOD AND DRUG ADMINISTRATION (FDA)
City	:	SILVER SPRING
State	:	MD
Zip	:	20903-1058
Country	:	US
Telephone Number	:	240-402-0034
Fax Number	:

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

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	01/20/2016

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