Individual
DR. JERRY CHONGMIN KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
8622 LEE HWY STE A, FAIRFAX, VA 22031-2148
(703) 876-4600
Mailing address
10243 BRITTENFORD DR, VIENNA, VA 22182-1867
(703) 716-0769
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401007221
VA
Other
Enumeration date
12/04/2006
Last updated
07/08/2007
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