Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 0024169791 | VA |
NPI | 1003076696 |
---|---|
Provider Name | Un Chong Kim |
First Address | Newport News, VA 23601-1318 |
Second Address | Hampton, VA 23666-6251 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2008 |
Last Update Date | 20/01/2014 |