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General NPI Number Information
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NPI Number | 1629119300
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Entity Type | Individual
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Provider Name | LILA KIM D.D.S
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Gender | Female
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 08/01/2023
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Provider Practice Location Address
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Address Line | 9010 LORTON STATION BLVD STE 140
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City | LORTON
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State | VA
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Zip | 22079-4794
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Country | US
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Telephone | 703-436-4633
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Fax |
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Provider Business Mailing Address
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Address Line | 9010 LORTON STATION BLVD STE 140
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City | LORTON
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State | VA
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Zip | 22079-4794
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Country | US
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Telephone | 703-436-4633
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 0401418353
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License Number State | VA
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