Healthcare Provider Details

I. General information

NPI: 1487692422
Provider Name (Legal Business Name): KIMBERLY K NAAHIELUA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 JOSEPH SIEWICK DR
FAIRFAX VA
22033-1709
US

IV. Provider business mailing address

916 EASTBROOKE LN
ROCHESTER NY
14618-5202
US

V. Phone/Fax

Practice location:
  • Phone: 703-391-3600
  • Fax:
Mailing address:
  • Phone: 585-507-0993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number0101239153
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: