Provider Demographics
NPI:1447230792
Name:KIM, CINDY H (MD)
Entity Type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:H
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:CINDY
Other - Middle Name:
Other - Last Name:HONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:43480 YUKON DRIVE
Mailing Address - Street 2:STE. 206
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-7915
Mailing Address - Country:US
Mailing Address - Phone:703-723-3201
Mailing Address - Fax:703-729-2736
Practice Address - Street 1:43480 YUKON DRIVE
Practice Address - Street 2:STE. 206
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-7915
Practice Address - Country:US
Practice Address - Phone:703-723-3201
Practice Address - Fax:703-729-2736
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101233632208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010084172Medicaid