Organization
VIRGINIA ORTHODONTICS AND PERIODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EUNYOUNG KIM (DR)
(703) 539-9166
Entity
Organization
Contact information
Practice address
301 MAPLE AVE W STE 440, VIENNA, VA 22180-4301
(703) 539-9166
Mailing address
301 MAPLE AVE W STE 440, VIENNA, VA 22180-4301
(703) 539-9166
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
0401412796
VA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
0401412701
VA
Other
Enumeration date
04/25/2012
Last updated
04/25/2012
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