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General NPI Number Information
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NPI Number | 1225528714
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Entity Type | Organization
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Legal Business Name | JKIM EYE CARE, O.D., PLLC
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Dates
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Enumeration Date | 05/10/2018
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Last Update Date | 03/08/2019
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Provider Practice Location Address
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Address Line | 5707 CENTRE SQUARE DR
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City | CENTREVILLE
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State | VA
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Zip | 20120-1916
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Country | US
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Telephone | 703-815-2500
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Fax | 703-815-2501
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Provider Business Mailing Address
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Address Line | 5707 CENTRE SQUARE DR
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City | CENTREVILLE
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State | VA
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Zip | 20120-1916
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Country | US
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Telephone | 703-815-2500
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL MEMEBER
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Name | DR. JOO HAN KIM
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Credential | OD
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Telephone | 703-815-2500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 0618001515
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License Number State | VA
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