MEDICARE: DR. HIE C 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	174400000X	Specialist	0101023599	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	250000292 C08088	OTHER	VA	MEDICARE VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001961 AND 454203	OTHER	VA	ANTHEM BCBS OF VA
2	27140	OTHER	VA	ALLIANCE PPO
3	4371 0001	OTHER	VA	CAREFIRST BCBS
4	22463	OTHER	VA	UNICARE
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	0787066	OTHER	VA	AETNA HMO
8	2020511-S	OTHER	VA	CIGNA
9	4054650	OTHER	VA	AETNA US HEALTHCARE PPO
10	001961 AND 454203	OTHER	VA	TRIGON VA
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	D-43711253	OTHER	VA	CHAMPUS TRICARE

General Provider Information

NPI Number	:	1346243805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HIE C KIM M.D.

Provider Business Mailing Address
First Line	:	8925 BURKE LAKE RD
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22151-1115
Country	:	US
Telephone Number	:	703-978-9595
Fax Number	:	703-978-2164

Provider Business Practice Location Address
First Line	:	8925 BURKE LAKE RD
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22151-1115
Country	:	US
Telephone Number	:	703-978-9595
Fax Number	:	703-978-2164

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	07/08/2007

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