Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 0119001253 | VA |
NPI | 1265976898 |
---|---|
Provider Name | Mrs. Kyung M Kim |
First Address | Centreville, VA 20121 |
Second Address | Centreville, VA 20121-2321 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2016 |
Last Update Date | 16/12/2016 |