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General NPI Number Information
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NPI Number | 1326529843
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Entity Type | Individual
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Provider Name | EDDIE HYUN KIM DC
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Gender | Male
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Dates
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Enumeration Date | 08/23/2018
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Last Update Date | 08/23/2018
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Provider Practice Location Address
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Address Line | 10340 DEMOCRACY LN STE 203
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City | FAIRFAX
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State | VA
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Zip | 22030-2518
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Country | US
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Telephone | 703-385-4773
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Fax |
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Provider Business Mailing Address
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Address Line | 4656 AUTUMN GLORY WAY
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City | CHANTILLY
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State | VA
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Zip | 20151-2361
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Country | US
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Telephone |
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 0104557502
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License Number State | VA
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