Provider Demographics
NPI:1427702893
Name:LAZARUS PSYCHIATRY LLC
Entity type:Organization
Organization Name:LAZARUS PSYCHIATRY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAE HOON
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-236-4669
Mailing Address - Street 1:7535 LITTLE RIVER TPKE STE 200A
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2988
Mailing Address - Country:US
Mailing Address - Phone:202-236-4669
Mailing Address - Fax:708-879-8208
Practice Address - Street 1:7535 LITTLE RIVER TPKE STE 200A
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2988
Practice Address - Country:US
Practice Address - Phone:202-236-4669
Practice Address - Fax:708-879-8208
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAZARUS PSYCHIATRY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-04
Last Update Date:2024-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1851345805OtherGROUP NPI