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General NPI Number Information
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NPI Number | 1124004023
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Entity Type | Individual
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Provider Name | ANDREW CHUL-WOOK KIM D.O.
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Gender | Male
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Dates
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Enumeration Date | 12/22/2005
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Last Update Date | 07/29/2008
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Provider Practice Location Address
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Address Line | 8725 JOHN J KINGMAN RD DTRA, STOP 6201
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City | FORT BELVOIR
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State | VA
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Zip | 22060-6217
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Country | US
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Telephone | 703-767-4997
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Fax | 703-767-4999
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Provider Business Mailing Address
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Address Line | 8618 SUNBEAM PL
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City | LAUREL
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State | MD
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Zip | 20723-5756
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Country | US
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Telephone | 410-792-2550
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | C2-0006489
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | C2-0006489
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License Number State | DE
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