Individual provider Active NPI

Young Kim, LCSW-W

  • Mental Health Counselor
  • Gaithersburg, MD
National Provider Identifier
1679222848
Registry record updated Mar 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
610 Professional Dr Ste 255
Gaithersburg, MD 20879-3463
Phone
(301) 979-8300
NPI assigned
Mar 23, 2022
Last updated
Mar 23, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU Primary

Addresses

Primary practice location

610 Professional Dr Ste 255
Gaithersburg, MD 20879-3463

Mailing address

610 Professional Dr Ste 255
Gaithersburg, MD 20879-3463
Phone (301) 979-8300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20241205004015 DC Practitioner - Mental Health Counselor 9133655749 Reassigns benefits to 1 organization
I20241209003613 VA Practitioner - Mental Health Counselor 9133655749 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Inova Health Care ServicesGroup PAC ID 2466351093, 1,821 clinicians

Practice addresses (Care Compare)

224 Cornwall St NW
Leesburg, VA 20176-2701
Phone (703) 771-2894

3300 Gallows Rd
Falls Church, VA 22042-3307
Phone (703) 776-4001

8505 Arlington Blvd
Fairfax, VA 22031-4630

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Inova Health Care Services CurrentSince Oct 28, 2024 Accepting new patients
Inova Health Care Services CurrentSince Oct 28, 2024 Accepting new patients
Inova Health Care Services CurrentSince Oct 28, 2024 Accepting new patients

Locations

8505 Arlington Blvd
Ste 200
Fairfax, VA 22031
Phone (703) 698-8525

224 Cornwall St NW
Leesburg, VA 20176
Phone (703) 771-2894

224B Cornwall St NW
Leesburg, VA 20176
Phone (703) 771-2894

44045 Riverside Pkwy
Leesburg, VA 20176
Phone (703) 858-6040

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1647993600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647993600000",
    "number": "1679222848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 PROFESSIONAL DR STE 255",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208793463",
            "telephone_number": "301-979-8300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 PROFESSIONAL DR STE 255",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208793463",
            "telephone_number": "301-979-8300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "YOUNG",
        "credential": "LCSW-W",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-23",
        "last_updated": "2022-03-23",
        "certification_date": "2022-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gaithersburg, MD

Sources for this page

Verify at the official NPI Registry.