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NPI Code Detail

MEDICARE: SEONG KIM MPA

MEDICARE: SEONG KIM MPA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant0110005471VA

General Provider Information

NPI Number : 1023569621
Entity Type Code : Individual
Provider Name (Legal Business Name) : SEONG KIM MPA
Provider Business Mailing Address
First Line : PO BOX 28503
Second Line :
City : BELFAST
State : ME
Zip : 04915-2037
Country : US
Telephone Number : 804-269-8291
Fax Number : 804-269-8293
Provider Business Practice Location Address
First Line : 5000 MONUMENT AVE FL 2
Second Line :
City : RICHMOND
State : VA
Zip : 23230-3627
Country : US
Telephone Number : 804-269-8291
Fax Number : 804-269-8293
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2016
Last Update Date : 07/18/2024

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Directions to “ SEONG KIM MPA” Practice Location

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