Provider Demographics
NPI:1346381951
Name:KIM, HO JIN (MD)
Entity Type:Individual
Prefix:DR
First Name:HO JIN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8371A GREENSBORO DR
Mailing Address - Street 2:
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-3529
Mailing Address - Country:US
Mailing Address - Phone:703-893-3710
Mailing Address - Fax:703-734-1404
Practice Address - Street 1:8371A GREENSBORO DR
Practice Address - Street 2:
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-3529
Practice Address - Country:US
Practice Address - Phone:703-893-3710
Practice Address - Fax:703-734-1404
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101226836207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101226836OtherSTATE LICENCE
G72423Medicare UPIN