Provider Demographics
NPI:1487988648
Name:MISUK KIM MD OBGYN PLC
Entity type:Organization
Organization Name:MISUK KIM MD OBGYN PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MI SUK
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-658-8282
Mailing Address - Street 1:4304 EVERGREEN LN
Mailing Address - Street 2:STE 104
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3216
Mailing Address - Country:US
Mailing Address - Phone:703-658-8282
Mailing Address - Fax:703-658-8283
Practice Address - Street 1:4304 EVERGREEN LN
Practice Address - Street 2:STE 104
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3216
Practice Address - Country:US
Practice Address - Phone:703-658-8282
Practice Address - Fax:703-658-8283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101244491207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty