Provider Demographics
NPI:1891599551
Name:KIM, MINJI (FNP)
Entity type:Individual
Prefix:
First Name:MINJI
Middle Name:
Last Name:KIM
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16178 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20855-2389
Mailing Address - Country:US
Mailing Address - Phone:240-463-0500
Mailing Address - Fax:
Practice Address - Street 1:16178 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20855-2389
Practice Address - Country:US
Practice Address - Phone:240-463-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR207259163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency