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General NPI Number Information
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NPI Number | 1154104586
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Entity Type | Individual
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Provider Name | JOONSOON KIM
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Gender | Male
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Dates
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Enumeration Date | 08/17/2023
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Last Update Date | 08/17/2023
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Provider Practice Location Address
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Address Line | 405 8TH ST NE
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City | WASHINGTON
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State | DC
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Zip | 20002-5227
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Country | US
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Telephone | 301-549-8951
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Fax |
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Provider Business Mailing Address
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Address Line | 8133 MANDAN TER
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City | GREENBELT
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State | MD
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Zip | 20770-2642
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Country | US
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Telephone | 301-549-8951
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 0019016254
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | R03568
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT200001263
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License Number State | DC
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