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General NPI Number Information
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NPI Number | 1407692676
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Entity Type | Organization
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Legal Business Name | BEACON HILL PSYCHIATRY
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Dates
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Enumeration Date | 07/08/2024
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Last Update Date | 07/08/2024
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Provider Practice Location Address
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Address Line | 7900 INTERNATIONAL DR STE 300-7067
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City | BLOOMINGTON
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State | MN
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Zip | 55425-1510
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Country | US
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Telephone | 646-825-6973
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Fax |
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Provider Business Mailing Address
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Address Line | 7900 INTERNATIONAL DR STE 300-7067
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City | BLOOMINGTON
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State | MN
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Zip | 55425-1510
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | JUNGJIN KIM
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Credential | MD
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Telephone | 646-532-9375
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084F0202X
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Taxonomy Name | Forensic Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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