MEDICARE: MR. KYUNG HAN KIM PT

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	225100000X	Physical Therapist	2305205254	VA

General Provider Information

NPI Number	:	1831210335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KYUNG HAN KIM PT

Provider Business Mailing Address
First Line	:	4304 EVERGREEN LN STE 102
Second Line	:
City	:	ANNANDALE
State	:	VA
Zip	:	22003-3216
Country	:	US
Telephone Number	:	703-256-7979
Fax Number	:	703-256-7770

Provider Business Practice Location Address
First Line	:	4304 EVERGREEN LN STE 102
Second Line	:
City	:	ANNANDALE
State	:	VA
Zip	:	22003-3216
Country	:	US
Telephone Number	:	703-256-7979
Fax Number	:	703-256-7770

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

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	06/06/2016

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