Provider Demographics
NPI:1477154516
Name:KIM IERNA KITCHEN DDS, PC
Entity Type:Organization
Organization Name:KIM IERNA KITCHEN DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:IERNA
Authorized Official - Last Name:KITCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-836-7000
Mailing Address - Street 1:500 MONTGOMERY ST STE 250
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-1558
Mailing Address - Country:US
Mailing Address - Phone:703-836-7000
Mailing Address - Fax:
Practice Address - Street 1:500 MONTGOMERY ST STE 250
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-1558
Practice Address - Country:US
Practice Address - Phone:703-836-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1134350853OtherASSOCIATE DENTIST