Active NPI
Jung Ja Kim, M.D.
- Anesthesiology Physician
- MC Lean, VA
National Provider Identifier
1992030399
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 0101025552
- Practice address
- 1229 Meyer CT
MC Lean, VA 22101-2319 - Phone
- (703) 356-1885
- NPI assigned
- Oct 2, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 0101025552 | VA | Primary |
| Family Medicine Physician | 207Q00000X | 0101025552 | VA |
Addresses
Primary practice location
1229 Meyer CT
MC Lean, VA 22101-2319
Mailing address
1229 Meyer CT
MC Lean, VA 22101-2319
Phone (703) 356-1885
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0101025552 | VA | MD | Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1254441600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1254441600000",
"number": "1992030399",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1229 MEYER CT",
"city": "MC LEAN",
"state": "VA",
"postal_code": "221012319",
"telephone_number": "703-356-1885"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1229 MEYER CT",
"city": "MC LEAN",
"state": "VA",
"postal_code": "221012319",
"telephone_number": "703-356-1885"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JUNG JA",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-10-02",
"last_updated": "2009-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "VA",
"license": "0101025552",
"primary": true
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "VA",
"license": "0101025552",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in MC Lean, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.