MEDICARE: KYUNG HEE KIM MS, CNS, LDN

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	133N00000X	Nutritionist	DX3658	MD

General Provider Information

NPI Number	:	1407244478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYUNG HEE KIM MS, CNS, LDN

Provider Business Mailing Address
First Line	:	4525 SALEM LN NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20007-1920
Country	:	US
Telephone Number	:	202-321-2801
Fax Number	:

Provider Business Practice Location Address
First Line	:	4525 SALEM LN NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20007-1920
Country	:	US
Telephone Number	:	202-321-2801
Fax Number	:

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

Provider Enumeration Date	:	12/29/2014
Last Update Date	:	12/29/2014

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