Healthcare Provider Details

I. General information

NPI: 1740322395
Provider Name (Legal Business Name): KIM GENTIN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3607 35TH ST NW
WASHINGTON DC
20016-3115
US

IV. Provider business mailing address

3607 35TH ST NW
WASHINGTON DC
20016-3115
US

V. Phone/Fax

Practice location:
  • Phone: 202-362-0200
  • Fax:
Mailing address:
  • Phone: 202-362-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY1000072
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY1000072
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPSY1000072
License Number StateDC
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPSY1000072
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: