Healthcare Provider Details

I. General information

NPI: 1811000565
Provider Name (Legal Business Name): JONAH N.K. ODIM MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9801 TRAVILLE COMMONS DR THE JNKO GROUP, LLC SUITE 302
ROCKVILLE MD
20850-7493
US

IV. Provider business mailing address

9801 TRAVILLE COMMONS DR THE JNKO GROUP, LLC SUITE 302
ROCKVILLE MD
20850-7493
US

V. Phone/Fax

Practice location:
  • Phone: 301-340-2823
  • Fax:
Mailing address:
  • Phone: 301-340-2823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberD0065408
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberD0065408
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberG83772
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberD0065408
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: