Jae Hoon Kim, CRNP-PMH

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

R189134 Issued in MD

Practice address

7201 Wisconsin Ave Ste 440
Bethesda, MD 20814-4851

Phone

(202) 236-4669

NPI assigned

Nov 19, 2012

Reactivated

Jul 22, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• Jaehoon Kim Other name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in DC, VA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse, Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: granatogroup.jaehoonkim@144557.advancedmd-direct.com

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.

• Lazarus Psychiatry LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Bethesda, MD
  • NPI 1962011205

  DC

  Medicare reassignment Authorized official
• Cornerstone Montgomery, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Bethesda, MD
  • NPI 1194725739

  DC

  Medicare reassignment NPD
• Inova Health Care Services

  • Internal Medicine Physician
  • Falls Church, VA
  • NPI 1952320061

  DC

  Medicare reassignment NPD
• Cornerstone Montgomery, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Rockville, MD
  • NPI 1134591985
  NPD
• Cornerstone Montgomery, Inc.

  • Adult Mental Health Clinic/Center
  • Silver Spring, MD
  • NPI 1174995781
  NPD
• Frederick Health Hospital Inc

  dba Frederick Health Hospital

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

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

{
    "created_epoch": "1353283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787443200000",
    "number": "1760726525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7201 WISCONSIN AVE STE 440",
            "city": "BETHESDA",
            "state": "MD",
            "postal_code": "208144851",
            "telephone_number": "202-236-4669",
            "fax_number": "708-879-8208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7201 WISCONSIN AVE STE 440",
            "city": "BETHESDA",
            "state": "MD",
            "postal_code": "208144851",
            "telephone_number": "202-236-4669"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7535 Little River Tpke Ste 200A",
            "address_purpose": "LOCATION",
            "city": "Annandale",
            "state": "VA",
            "postal_code": "220032988",
            "country_code": "US",
            "telephone_number": "202-236-4669",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "JAE HOON",
        "name_prefix": "Mr.",
        "credential": "CRNP-PMH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-11-19",
        "last_updated": "2026-08-23",
        "certification_date": "2026-08-23",
        "deactivation_date": "2020-07-10",
        "reactivation_date": "2020-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "VA",
            "license": "0024178821",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R189134",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "822275",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30015955680008",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "587108500",
            "state": "MD"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@lazaruspsychiatry.com",
            "affiliation": "N",
            "endpointDescription": "Secure Clinic Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "7201 Wisconsin Ave Ste 440",
            "city": "Bethesda",
            "state": "MD",
            "country_code": "US",
            "postal_code": "208144851",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JAEHOON",
            "last_name": "KIM",
            "credential": "CRNP-PMH",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Geoffrey Kim, M.D.
• Gregory Jaeduk Kim, PHARMD
• Haedong Kim
• Hyuntae Kim
• Ick Ho Kim, NP-C
• Janet Kim, L.AC
• Jinmin Kim
• Katherine Kim, PHARMD
• Kyoung Hwan Kim, L. AC
• Manuel Kim, P.T.

• Psychiatric/Mental Health Nurse Practitioner in Bethesda, MD
• Providers in Bethesda, MD by specialty
• Psychiatric/Mental Health Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2026; 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.
• 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.