Healthcare Provider Details

I. General information

NPI: 1447707260
Provider Name (Legal Business Name): ERIC JIHUN KIM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2016
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16708 RICHMOND HWY STE 115
DUMFRIES VA
22026-2770
US

IV. Provider business mailing address

21475 RIDGETOP CIR STE 200
STERLING VA
20166-8504
US

V. Phone/Fax

Practice location:
  • Phone: 703-221-4040
  • Fax:
Mailing address:
  • Phone: 703-444-3710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0401416511131
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number16871
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: