Jeeho Damian Kim, MD

Primary specialty

Military Health Care ProviderTaxonomy code 171000000X

License

0101270560 Issued in VA

Practice address

1 San Diego Loop BLDG 3282
JB Andrews, MD 20762-5518

Phone

(240) 303-2050

NPI assigned

Apr 4, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1554336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617926400000",
    "number": "1316409667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 SAN DIEGO LOOP BLDG 3282",
            "city": "JB ANDREWS",
            "state": "MD",
            "postal_code": "207625518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 SAN DIEGO LOOP BLDG 3282",
            "city": "JB ANDREWS",
            "state": "MD",
            "postal_code": "207625518",
            "telephone_number": "240-303-2050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JEEHO",
        "middle_name": "DAMIAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-04",
        "last_updated": "2021-04-09",
        "certification_date": "2021-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": "VA",
            "license": "0101270560",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "N/A",
            "affiliation": "N",
            "address_1": "1 San Diego Loop Bldg 3282",
            "city": "Jb Andrews",
            "state": "MD",
            "country_code": "US",
            "postal_code": "207625518",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Noah Jo
• April Jones-Faulkner
• Christopher Henry Jordan
• Gregory Chad Kahl, MD
• Dominic Kim, MD
• Nathan Marc Kinder, DO
• Pei-Ying Chang Kobres
• Erik K Koda, MD
• Carly Koenig
• Albert Kennedy Koerner, M.D.

• Military Health Care Provider in JB Andrews, MD
• Providers in JB Andrews, MD by specialty
• Military Health Care Provider in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.