MEDICARE: DR. JEEHO DAMIAN KIM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171000000X	Military Health Care Provider	0101270560	VA

General Provider Information

NPI Number	:	1316409667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEEHO DAMIAN KIM MD

Provider Business Mailing Address
First Line	:	1 SAN DIEGO LOOP BLDG 3282
Second Line	:
City	:	JB ANDREWS
State	:	MD
Zip	:	20762-5518
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 SAN DIEGO LOOP BLDG 3282
Second Line	:
City	:	JB ANDREWS
State	:	MD
Zip	:	20762-5518
Country	:	US
Telephone Number	:	240-303-2050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2019
Last Update Date	:	04/09/2021

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