1275538076 NPI number — DR. EDWARD C KIM MD

Table of content: DR. EDWARD C KIM MD (NPI 1275538076)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275538076 NPI number — DR. EDWARD C KIM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIM
Provider First Name:
EDWARD
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275538076
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8640 SUDLEY RD STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANASSAS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20110-4404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-368-6819
Provider Business Mailing Address Fax Number:
703-330-2923

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8640 SUDLEY RD STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANASSAS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20110-4404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-368-6819
Provider Business Practice Location Address Fax Number:
703-330-2923
Provider Enumeration Date:
06/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  0101045874 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 005847052 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2431908 . This is a "AETNA HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 284691 . This is a "MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7206160 . This is a "AETNA PPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 92130005 . This is a "CAREFIRST" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 317528 . This is a "ANTHEM/WARRENTON" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 3781769003 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 317527 . This is a "ANTHEM/MANASSAS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 541604636 . This is a "VIRGINIA HEALTH NETWORK" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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