Provider Demographics
NPI:1285849380
Name:KIM, JIN W (DC)
Entity Type:Individual
Prefix:
First Name:JIN
Middle Name:W
Last Name:KIM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7023 LITTLE RIVER TPKE
Mailing Address - Street 2:#409
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-5939
Mailing Address - Country:US
Mailing Address - Phone:703-691-3111
Mailing Address - Fax:
Practice Address - Street 1:7023 LITTLE RIVER TPKE
Practice Address - Street 2:#409
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-5939
Practice Address - Country:US
Practice Address - Phone:703-691-3111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA001441111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA491289Medicare ID - Type Unspecified