Healthcare Provider Details

I. General information

NPI: 1619651627
Provider Name (Legal Business Name): CAPITOL HILL WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 06/12/2023
Certification Date: 06/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 E CAPITOL ST NE STE G
WASHINGTON DC
20003-3809
US

IV. Provider business mailing address

326 E CAPITOL ST NE STE G
WASHINGTON DC
20003-3809
US

V. Phone/Fax

Practice location:
  • Phone: 202-503-3940
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL KIM
Title or Position: AO
Credential:
Phone: 202-503-3940