Healthcare Provider Details

I. General information

NPI: 1558351684
Provider Name (Legal Business Name): CHUNHUI J KIM RN, BSN, COHN-S
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 LLEWELLYN AVE
FT MEADE MD
20755-5800
US

IV. Provider business mailing address

10290 BURLEIGH COTTAGE LN
ELLICOTT CITY MD
21042-5806
US

V. Phone/Fax

Practice location:
  • Phone: 301-677-8390
  • Fax: 301-677-8876
Mailing address:
  • Phone: 410-480-4958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License NumberR106674
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: