BNM, Inc.
Organization Active NPI Pediatrics Physician · Fairfax, VA
NPI 1033535778 · NPPES record last updated May 5, 2014
Key facts
- NPI
- 1033535778
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatrics Physician 208000000X
- Legal business name
- BNM, INC.
- Practice address
- 12011 Lee Jackson Memorial Hwy
Suite 220
Fairfax, VA 22033-3310 - Phone
- (703) 865-5437
- NPI assigned
- Mar 5, 2014
- Organization subpart
- No
Authorized official
- Name
- Dr. Christina Soh Yun Jung, MD
- Title
- President
- Phone
- (703) 865-5437
Practitioners 3
-
Christina Jung, M.D.
-
Catherine Haerin Cho, PA-C
-
Hailey H Jun, FNP-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 49D2082478 | BNM, Inc Dba My Kid'S Pediatrics and Adolescent | Certificate of waiver | Aug 14, 2026 |
National Provider Directory
Locations
12011 Route 50
Ste 220
Fairfax, VA 22033
Phone (703) 865-5437
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician |
208000000X | Yes |
Addresses
Primary practice location
12011 Lee Jackson Memorial Hwy
Suite 220
Fairfax, VA 22033-3310
Mailing address
12011 Lee Jackson Memorial Hwy
Suite 220
Fairfax, VA 22033-3310
Phone (703) 865-5437
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 556505700 | Medicaid | MD | |
| 1639326796 | Medicaid | VA |
Other names
- My Kid's Pediatrics and Adolescent Care
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- Janet Boateng
- Krzysztof M Bochenek
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All providers in Fairfax, VA · Pediatrics Physician in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 5, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.