Provider Demographics
NPI:1255307906
Name:KIM, BYUNGKI (MD)
Entity Type:Individual
Prefix:
First Name:BYUNGKI
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3700 JOSEPH SIEWICK DR
Mailing Address - Street 2:SUITE 308
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033
Mailing Address - Country:US
Mailing Address - Phone:703-698-8960
Mailing Address - Fax:703-716-8703
Practice Address - Street 1:3028 JAVIER RD STE 500
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4622
Practice Address - Country:US
Practice Address - Phone:703-698-8960
Practice Address - Fax:571-494-5794
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101227056207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA79160013OtherCAREFIRST BCBS
VA187450OtherANTHEM BCBS
VA317110OtherANTHEM BCBS
VA178735OtherANTHEM BCBS
VA100014968OtherRAILROAD MEDICARE
VA187601OtherANTHEM BCBS
VA317111OtherANTHEM BCBS
VA5844541Medicaid
VA187601OtherANTHEM BCBS
VA187450OtherANTHEM BCBS