Provider Demographics
NPI:1023569621
Name:KIM, SEONG (MPA)
Entity Type:Individual
Prefix:
First Name:SEONG
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8002 DISCOVERY DR.
Mailing Address - Street 2:STE 215
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23229
Mailing Address - Country:US
Mailing Address - Phone:804-269-8291
Mailing Address - Fax:804-269-8293
Practice Address - Street 1:8002 DISCOVERY DR
Practice Address - Street 2:STE 215
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229
Practice Address - Country:US
Practice Address - Phone:804-269-8291
Practice Address - Fax:804-269-8293
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110005471363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical