Individual
JI SUN KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3823 MAHER MNR, GLEN ALLEN, VA 23060-5979
(919) 450-7550
Mailing address
3823 MAHER MNR, GLEN ALLEN, VA 23060-5979
(919) 450-7550
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
0401415219
VA
Other
Enumeration date
11/13/2016
Last updated
11/13/2016
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