Provider Demographics
NPI:1255611935
Name:KIM, HEE JIN (LAC)
Entity type:Individual
Prefix:MS
First Name:HEE
Middle Name:JIN
Last Name:KIM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:451 HUNGERFORD DR STE 601
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-5105
Mailing Address - Country:US
Mailing Address - Phone:301-579-3311
Mailing Address - Fax:301-579-3311
Practice Address - Street 1:451 HUNGERFORD DR STE 601
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-5105
Practice Address - Country:US
Practice Address - Phone:301-579-3311
Practice Address - Fax:301-579-3311
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000569171100000X
MDU02091171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist