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1053350116 NPI number — WILSON KIM DDS

NPI Number: 1053350116
Health Care Provider/Practitioner: WILSON KIM DDS

Information about “1053350116” NPI (WILSON KIM DDS) exists in 1053350116 in HTML format HTML  |  1053350116 in plain Text format TXT  |  1053350116 in PDF (Portable Document Format) PDF  |  1053350116 in an XML format XML  formats.

NPI Number : 1053350116 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1053350116",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KIM",
    "FirstName": "WILSON",
    "MiddleName": null,
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DDS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1316 COLVIN FOREST DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "VIENNA",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "22182-1318",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "917-449-2776",
    "MailingAddressFaxNumber": "703-992-7284",
    "FirstLinePracticeLocationAddress": "8251 GREENSBORO DR",
    "SecondLinePracticeLocationAddress": "SUITE #102",
    "PracticeLocationAddressCityName": "MC LEAN",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "22102-4900",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "702-992-7272",
    "PracticeLocationAddressFaxNumber": "703-992-7284",
    "EnumerationDate": "06/05/2006",
    "LastUpdateDate": "05/07/2015",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "1223G0001X",
        "TaxonomyName": "General Practice Dentistry",
        "LicenseNumber": "0401411002",
        "LicenseNumberStateCode": "VA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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