Healthcare Provider Details

I. General information

NPI: 1760874051
Provider Name (Legal Business Name): YOUNG KI KIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2015
Last Update Date: 10/12/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7361 MCWHORTER PL STE 300
ANNANDALE VA
22003-5649
US

IV. Provider business mailing address

7361 MCWHORTER PL STE 300
ANNANDALE VA
22003-5649
US

V. Phone/Fax

Practice location:
  • Phone: 703-750-1277
  • Fax:
Mailing address:
  • Phone: 703-750-1277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0121000963
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019007207
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: