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General NPI Number Information
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NPI Number | 1730407792
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Entity Type | Individual
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Provider Name | CHUNG W KIM RPH
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Gender | Female
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Dates
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Enumeration Date | 05/13/2010
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Last Update Date | 05/13/2010
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Provider Practice Location Address
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Address Line | 448 S KING ST
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City | LEESBURG
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State | VA
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Zip | 20175-3619
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Country | US
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Telephone | 703-777-3111
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Fax |
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Provider Business Mailing Address
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Address Line | 19195 BURNT BRIDGE DR
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City | LEESBURG
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State | VA
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Zip | 20176-1267
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Country | US
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Telephone | 571-223-1086
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0202205259
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License Number State | VA
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