=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801017223
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HO JIN KIM, MD, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2007
-----------------------------------------------------
Last Update Date | 04/12/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8371A GREENSBORO DR
-----------------------------------------------------
City | MC LEAN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22102-3529
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-893-3710
-----------------------------------------------------
Fax | 703-734-1404
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8371A GREENSBORO DR
-----------------------------------------------------
City | MC LEAN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22102-3529
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-893-3710
-----------------------------------------------------
Fax | 703-734-1404
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | DR. HO JIN KIM
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 703-893-3710
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | 0101226836
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------