MEDICARE: DR. RICHARD K KIM M.D.

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
1	2084P0800X	Psychiatry Physician	125048799	IL
2	2084P0800X	Psychiatry Physician	0101244221	VA

General Provider Information

NPI Number	:	1265696983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD K KIM M.D.

Provider Business Mailing Address
First Line	:	1307 DOLLEY MADISON BLVD STE 3C
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22101-3913
Country	:	US
Telephone Number	:	703-336-2406
Fax Number	:	703-646-7584

Provider Business Practice Location Address
First Line	:	1307 DOLLEY MADISON BLVD STE 3C
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22101-3913
Country	:	US
Telephone Number	:	703-336-2406
Fax Number	:	703-646-7584

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2008
Last Update Date	:	08/29/2023

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