Provider Demographics
NPI:1497066229
Name:TIMOTHY KIM &THOMAS KIM, DDS, PC
Entity Type:Organization
Organization Name:TIMOTHY KIM &THOMAS KIM, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-378-5777
Mailing Address - Street 1:5900 FORT DR STE 209
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-2425
Mailing Address - Country:US
Mailing Address - Phone:703-378-5777
Mailing Address - Fax:703-378-5776
Practice Address - Street 1:5900 FORT DR STE 209
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2425
Practice Address - Country:US
Practice Address - Phone:703-378-5777
Practice Address - Fax:703-378-5776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-25
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014106341223G0001X
VA04014107571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty