Provider Demographics
NPI:1487676672
Name:DO, KIM QUY (DDS)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:QUY
Last Name:DO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8303 ARLINGTON BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2903
Mailing Address - Country:US
Mailing Address - Phone:703-876-2606
Mailing Address - Fax:703-876-2627
Practice Address - Street 1:8303 ARLINGTON BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2903
Practice Address - Country:US
Practice Address - Phone:703-876-2606
Practice Address - Fax:703-876-2627
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010069731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
0084916OtherANTHEM
0000000039191OtherDENTAL BENEFIT PROVIDERS
0000000039191OtherUNITED HEALTHCARE
54-121-44OtherAETNA HEALTH PLAN
VA9178677Medicaid