Provider Demographics
NPI:1023089760
Name:HARRIS, JOSEPH KIM (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:KIM
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7301 FOREST AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3792
Mailing Address - Country:US
Mailing Address - Phone:804-288-2767
Mailing Address - Fax:804-288-9897
Practice Address - Street 1:165 WADSWORTH DR
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-4500
Practice Address - Country:US
Practice Address - Phone:804-272-9146
Practice Address - Fax:804-272-5929
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01010349622084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6102557Medicaid
VA6102557Medicaid
130000526Medicare ID - Type Unspecified