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General NPI Number Information
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NPI Number | 1699239293
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Entity Type | Individual
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Provider Name | JUNG MI KIM NP
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Gender | Female
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Dates
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Enumeration Date | 01/28/2019
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 1230 ALVERSER DR STE 100
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City | MIDLOTHIAN
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State | VA
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Zip | 23113-2653
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Country | US
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Telephone | 804-893-7800
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Fax |
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Provider Business Mailing Address
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Address Line | 3924 LIESFELD PL
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City | GLEN ALLEN
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State | VA
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Zip | 23060-6018
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Country | US
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Telephone | 804-426-7380
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024177280
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License Number State | VA
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