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General NPI Number Information
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NPI Number | 1093194821
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Entity Type | Organization
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Legal Business Name | MCLEAN PSYCHIATRIC SERVICES LLC
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Dates
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Enumeration Date | 05/26/2015
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Last Update Date | 06/02/2015
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Provider Practice Location Address
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Address Line | 6832 OLD DOMINION DR STE 200
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City | MC LEAN
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State | VA
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Zip | 22101-3827
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Country | US
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Telephone | 703-336-2406
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Fax |
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Provider Business Mailing Address
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Address Line | 6832 OLD DOMINION DR STE 200
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City | MC LEAN
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State | VA
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Zip | 22101-3827
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Country | US
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Telephone | 703-646-7584
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Fax |
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Authorized Official
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Title or Position | MEMBER/MANAGER
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Name | DR. RICHARD K KIM
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Credential | M.D.
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Telephone | 703-336-2406
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0101244221
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License Number State | VA
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