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General NPI Number Information
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NPI Number | 1053350116
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Entity Type | Individual
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Provider Name | WILSON KIM DDS
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Gender | Male
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Dates
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Enumeration Date | 06/05/2006
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Last Update Date | 05/07/2015
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Provider Practice Location Address
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Address Line | 8251 GREENSBORO DR SUITE #102
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City | MC LEAN
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State | VA
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Zip | 22102-4900
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Country | US
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Telephone | 702-992-7272
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Fax | 703-992-7284
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Provider Business Mailing Address
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Address Line | 1316 COLVIN FOREST DR
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City | VIENNA
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State | VA
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Zip | 22182-1318
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Country | US
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Telephone | 917-449-2776
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Fax | 703-992-7284
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401411002
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License Number State | VA
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