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General NPI Number Information
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NPI Number | 1467315903
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Entity Type | Individual
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Provider Name | JASON WOOJU KIM
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Gender | Male
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Dates
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Enumeration Date | 12/03/2025
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 344 UNIVERSITY BLVD W
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City | SILVER SPRING
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State | MD
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Zip | 20901-1948
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Country | US
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Telephone | 844-796-2797
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Fax |
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Provider Business Mailing Address
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Address Line | 4042 HEATHERSTONE CT
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City | FAIRFAX
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State | VA
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Zip | 22030-7452
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Country | US
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Telephone | 703-593-1812
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 0402207363
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License Number State | VA
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