1346243805 NPI number — DR. HIE C KIM M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346243805 NPI number — DR. HIE C KIM M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

KIM

Provider First Name:

HIE

Provider Middle Name:

C

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

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:

1346243805

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/08/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

8925 BURKE LAKE RD

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

SPRINGFIELD

Provider Business Mailing Address State Name:

VA

Provider Business Mailing Address Postal Code:

22151-1115

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

703-978-9595

Provider Business Mailing Address Fax Number:

703-978-2164

Provider First Line Business Practice Location Address:

8925 BURKE LAKE RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

SPRINGFIELD

Provider Business Practice Location Address State Name:

VA

Provider Business Practice Location Address Postal Code:

22151-1115

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

703-978-9595

Provider Business Practice Location Address Fax Number:

703-978-2164

Provider Enumeration Date:

05/27/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 174400000X , with the licence number:  0101023599 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 001961 AND 454203 . This is a "ANTHEM BCBS OF VA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 27140 . This is a "ALLIANCE PPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 4371 0001 . This is a "CAREFIRST BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 22463 . This is a "UNICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 250000292 C08088 . This is a "MEDICARE VA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 6861954 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
• Identifier: 0787066 . This is a "AETNA HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 2020511-S . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 4054650 . This is a "AETNA US HEALTHCARE PPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 001961 AND 454203 . This is a "TRIGON VA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 6861954 . This is a "MEDICAID VA HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: D-43711253 . This is a "CHAMPUS TRICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".