Provider Demographics
NPI:1508469420
Name:HOSEN, KIM CYNTHIA
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:CYNTHIA
Last Name:HOSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 CLARKES LANDING DR
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-1119
Mailing Address - Country:US
Mailing Address - Phone:703-674-7436
Mailing Address - Fax:
Practice Address - Street 1:43330 JUNCTION PLZ
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-3406
Practice Address - Country:US
Practice Address - Phone:703-723-2161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-21
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202006491183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist