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Individual

MICHAEL KIM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
42015 VILLAGE CENTER PLZ STE 103, STONE RIDGE, VA 20105-3031
(703) 542-8888
Mailing address
12640 MAGNA CARTA RD, HERNDON, VA 20171-2709
(703) 579-7019

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618002949
VA

Other

Enumeration date
01/08/2021
Last updated
01/08/2021
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