Provider Demographics
NPI:1578552576
Name:KIL, HYUNG JOON (MD)
Entity Type:Individual
Prefix:
First Name:HYUNG
Middle Name:JOON
Last Name:KIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 CARE WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-8439
Mailing Address - Country:US
Mailing Address - Phone:540-373-4900
Mailing Address - Fax:540-373-5195
Practice Address - Street 1:1011 CARE WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-8439
Practice Address - Country:US
Practice Address - Phone:540-373-4900
Practice Address - Fax:540-373-5195
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041112207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6221106Medicaid
B08955Medicare UPIN
160000446Medicare PIN