Organization Active NPI

LJ Medical LLC

  • Family Medicine Physician
  • Rockville, MD
National Provider Identifier
1750993663
Registry record updated Apr 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
LJ MEDICAL LLC
Practice address
121 Congressional LN Ste 204
Rockville, MD 20852-1542
Phone
(301) 917-4139
Fax
(877) 803-4509
NPI assigned
Aug 21, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2025

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

Authorized official

Name
Malvis Tamon, MDNPI 1679059794
Title
Ceo
Phone
(240) 426-3316

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

121 Congressional LN Ste 204
Rockville, MD 20852-1542

Mailing address

121 Congressional LN Ste 204
Rockville, MD 20852-1542
Phone (301) 917-4139

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201124000025 DC Part B Supplier - Clinic/Group Practice 2769893767 Receives reassigned benefits from 1 practitioner
Practice locations: Rockville, MD

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
21D2216766LJ Medical Health and Wellness Clinic121 Congressional Lane Ste 204, Rockville, MD 20852Certificate of waiverMar 15, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1597968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745971200000",
    "number": "1750993663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 CONGRESSIONAL LN STE 204",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208521542",
            "telephone_number": "301-917-4139",
            "fax_number": "877-803-4509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 CONGRESSIONAL LN STE 204",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208521542",
            "telephone_number": "301-917-4139",
            "fax_number": "877-803-4509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LJ MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-21",
        "last_updated": "2025-04-30",
        "certification_date": "2025-04-30",
        "status": "A",
        "authorized_official_last_name": "TAMON",
        "authorized_official_first_name": "MALVIS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "240-426-3316",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.