Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 0101023297 | VA |
NPI | 1154435063 |
---|---|
Provider Name | Mi Yong Kim |
First Address | Fairfax, VA 22030 |
Second Address | Fairfax, VA 22030 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 08/07/2007 |