Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 0101259733 | VA |
Y | 207YS0123X | Facial Plastic Surgeon | 0101259733 | VA |
NPI | 1609168327 |
---|---|
Provider Name | Dr. Jae Y Kim |
First Address | Arlington, VA 22201-3397 |
Second Address | Arlington, VA 22201-3397 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2011 |
Last Update Date | 15/11/2018 |