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14804 Physicians Lane Suite 122 Rockville MD 20850-3912 | |
| (301) 424-7700 | |
| (301) 424-0305 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 14804 Physicians Lane, Rockville, Maryland |
| Authorized Official Name and Position | Hei-jung C Kim (DIRECTOR/OWNER) |
| Authorized Official Contact | 3014247700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
14804 Physicians Lane Suite 122 Rockville MD 20850-3912 Ph: (301) 424-7700 | 14804 Physicians Lane Suite 122 Rockville MD 20850-3912 Ph: (301) 424-7700 |
| NPI Number | 1417057217 |
|---|---|
| Provider Enumeration Date | 09/22/2006 |
| Last Update Date | 10/19/2016 |
| Medicare PECOS PAC ID | 5991846586 |
|---|---|
| Medicare Enrollment ID | O20100127000677 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417057217 | NPI | - | NPPES |
| 404107100 | Medicaid | MD | |
| 483700200 | Medicaid | MD | |
| 718500600 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 09979 (Maryland) | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | D32686 (Maryland) | Primary |
| Provider Name | Hei Jung C Kim |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1275633075 PECOS PAC ID: 5698748739 Enrollment ID: I20040817000289 |
| Provider Name | Sunny S Park |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588821094 PECOS PAC ID: 7416993142 Enrollment ID: I20050705000493 |
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