Provider Demographics
NPI:1073091807
Name:KIM, ASHLEY AEJIN (OD)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:AEJIN
Last Name:KIM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:11645 ANGUS RD STE 5
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4020
Practice Address - Country:US
Practice Address - Phone:512-345-5641
Practice Address - Fax:512-345-0863
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-02
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX9538152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist