Healthcare Provider Details

I. General information

NPI: 1902773559
Provider Name (Legal Business Name): ROBERT KIM DNP, FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 UNIVERSITY BLVD E
SILVER SPRING MD
20901-2436
US

IV. Provider business mailing address

10980 GRANTCHESTER WAY
COLUMBIA MD
21044-6097
US

V. Phone/Fax

Practice location:
  • Phone: 855-910-3278
  • Fax:
Mailing address:
  • Phone: 877-772-6505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR233718
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: