# JAE KIM, MD PLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Jae Kim, MD Facial Plastic Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306308382
- **Authorized official:** JAE KIM (AUTHORIZED MEMBER)
- **Authorized official phone:** (347) 551-1113

## Contact information

- **Practice address:** 10721 MAIN ST STE 205, FAIRFAX, VA 22030-6902
- **Practice address phone:** (703) 705-2100
- **Practice address fax:** (703) 935-0330
- **Mailing address:** 2200 WILSON BLVD STE 102-219, ARLINGTON, VA 22201-3397

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207YS0123X | Facial Plastic Surgery Physician | — | NULL | Yes |
| 207YS0123X | Facial Plastic Surgery Physician | — | — | Yes |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 04/01/2019
- **Last updated:** 06/11/2019