Provider Demographics
NPI:1508017716
Name:KIM, MISUK AGNES (MD)
Entity type:Individual
Prefix:
First Name:MISUK
Middle Name:AGNES
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4304 EVERGREEN LN STE 101
Mailing Address - Street 2:
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 1:4308 EVERGREEN LN
Practice Address - Street 2:STE F
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3276
Practice Address - Country:US
Practice Address - Phone:703-658-8282
Practice Address - Fax:703-658-8283
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2020-05-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101244491207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology