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General NPI Number Information
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NPI Number | 1285832535
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Entity Type | Organization
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Legal Business Name | LANDMARK INTERNAL MEDICINE, LLC
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Dates
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Enumeration Date | 07/09/2007
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Last Update Date | 01/04/2010
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Provider Practice Location Address
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Address Line | 6300 STEVENSON AVE SUITE B
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City | ALEXANDRIA
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State | VA
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Zip | 22304-3576
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Country | US
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Telephone | 703-370-0778
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Fax | 703-212-7083
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Provider Business Mailing Address
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Address Line | PO BOX 2646
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City | FAIRFAX
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State | VA
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Zip | 22031-0646
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Country | US
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Telephone | 703-323-0589
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Fax |
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Authorized Official
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Title or Position | MD
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Name | DR. JOHN K KIM
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Credential | M.D.
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Telephone | 703-370-0785
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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 | 0101230358
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License Number State | VA
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