Provider Demographics
NPI:1609436989
Name:KIM, HANWOOL (DDS)
Entity Type:Individual
Prefix:DR
First Name:HANWOOL
Middle Name:
Last Name:KIM
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 1:8059 ASHLAND AVE APT 11
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-8059
Mailing Address - Country:US
Mailing Address - Phone:703-717-8408
Mailing Address - Fax:
Practice Address - Street 1:8303 ARLINGTON BLVD STE 104
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2903
Practice Address - Country:US
Practice Address - Phone:703-207-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014164491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice