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General NPI Number Information
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NPI Number | 1992355473
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Entity Type | Individual
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Provider Name | CANDACE BAHK KIM DC
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Gender | Female
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Dates
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Enumeration Date | 09/16/2019
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Last Update Date | 09/16/2019
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Provider Practice Location Address
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Address Line | 6225 BRANDON AVE STE 175
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City | SPRINGFIELD
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State | VA
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Zip | 22150-2519
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Country | US
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Telephone | 202-352-3396
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Fax |
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Provider Business Mailing Address
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Address Line | 485 HARBOR SIDE ST APT 402
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City | WOODBRIDGE
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State | VA
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Zip | 22191-5458
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Country | US
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Telephone |
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 0104557463
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License Number State | VA
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