Healthcare Provider Details

I. General information

NPI: 1598523052
Provider Name (Legal Business Name): JIN HA KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8601 ASHBURY HILLS TER
RICHMOND VA
23227-1266
US

IV. Provider business mailing address

8601 ASHBURY HILLS TER
RICHMOND VA
23227-1266
US

V. Phone/Fax

Practice location:
  • Phone: 804-439-7349
  • Fax:
Mailing address:
  • Phone: 804-439-7349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0008X
TaxonomyOral and Maxillofacial Radiology Dentistry
License Number0401419966
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: