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General NPI Number Information
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NPI Number | 1033181060
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Entity Type | Individual
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Provider Name | KYONGSOOK KIM NP
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Gender | Female
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Dates
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Enumeration Date | 02/03/2006
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Last Update Date | 04/08/2023
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Provider Practice Location Address
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Address Line | 1380 SOUTHERN AVE SE
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City | WASHINGTON
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State | DC
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Zip | 20032-4623
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Country | US
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Telephone | 202-279-5880
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Fax |
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Provider Business Mailing Address
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Address Line | 18500 NEW HAMPSHIRE AVE
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City | ASHTON
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State | MD
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Zip | 20861-9788
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Country | US
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Telephone | 240-330-0999
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | RN962194
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | R151075
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License Number State | MD
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