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General NPI Number Information
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NPI Number | 1437426509
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Entity Type | Organization
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Legal Business Name | PETER HD KIM, DDS
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Dates
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Enumeration Date | 11/17/2011
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Last Update Date | 11/17/2011
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Provider Practice Location Address
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Address Line | 14136 MINNIEVILLE RD
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City | WOODBRIDGE
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State | VA
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Zip | 22193-2313
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Country | US
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Telephone | 703-583-4466
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Fax | 703-583-4477
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Provider Business Mailing Address
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Address Line | 14136 MINNIEVILLE RD
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City | WOODBRIDGE
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State | VA
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Zip | 22193-2313
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Country | US
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Telephone | 703-583-4466
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Fax | 703-583-4477
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. JINA KIM
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Credential |
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Telephone | 703-583-4466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 10073
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License Number State | VA
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