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Organization
JAE KIM, MD PLC
Active
Organization
JAE KIM, MD PLC
Active
Other names
Jae Kim, MD Facial Plastic Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
JAE KIM (AUTHORIZED MEMBER)
(347) 551-1113
Entity
Organization
Contact information
Practice address
10721 MAIN ST STE 205, FAIRFAX, VA 22030-6902
(703) 705-2100
(703) 935-0330
Mailing address
2200 WILSON BLVD STE 102-219, ARLINGTON, VA 22201-3397
Taxonomy
Speciality
Code
Description
License number
State
207YS0123X
Facial Plastic Surgery Physician
Primary
—
NULL
207YS0123X
Facial Plastic Surgery Physician
Primary
—
—
261QM2500X
Medical Specialty Clinic/Center
—
NULL
Other
Enumeration date
04/01/2019
Last updated
06/11/2019
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