MEDICARE: DR. SUNGHEE KIM D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	0401413600	VA

General Provider Information

NPI Number	:	1023420619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUNGHEE KIM D.D.S

Provider Business Mailing Address
First Line	:	2843 HARTLAND RD STE 200
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22043-3539
Country	:	US
Telephone Number	:	703-849-1300
Fax Number	:

Provider Business Practice Location Address
First Line	:	2843 HARTLAND RD STE 200
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22043-3539
Country	:	US
Telephone Number	:	703-849-1300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2014
Last Update Date	:	01/11/2016

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