Individual
KI S KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
N.P.
Contact information
Practice address
1900 GALLOWS RD STE 110, VIENNA, VA 22182-4098
(703) 281-1265
(703) 255-0571
Mailing address
2901 TELESTAR CT STE 300, FALLS CHURCH, VA 22042-1263
(703) 591-1688
(703) 591-1445
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024171030
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1447683073
—
VA
Enumeration date
08/19/2013
Last updated
08/23/2024
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