Healthcare Provider Details

I. General information

NPI: 1700723186
Provider Name (Legal Business Name): YONG JI KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8026 TREVOR PL
VIENNA VA
22182-4019
US

IV. Provider business mailing address

8026 TREVOR PL 8026 TREVOR PLACE
VIENNA VA
22182-4019
US

V. Phone/Fax

Practice location:
  • Phone: 703-268-9248
  • Fax:
Mailing address:
  • Phone: 703-268-9248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024197150
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: