Doctor Name: | MICHAEL KIM |
NPI Number: | 1235495219 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 3600 Joseph Siewick Dr Fairfax, VA - 220331709 |
Business Phone Number: | 7033913558 |
Business Fax Number: | 7033913441 |
Mailing Address: | Po Box 9150, PADUCAH |
State: | KY |
Postal Code: | 420029150 |
Phone Number: | 2707449600 |
Fax Number: | 2707448642 |
NPI Enumeration Date: | 04/04/2012 |
NPI Last Update Date: | 09/04/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |