Provider Demographics
NPI:1619966975
Name:KIL, HYUNG JAE (MD)
Entity Type:Individual
Prefix:
First Name:HYUNG
Middle Name:JAE
Last Name:KIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:H JAE
Other - Middle Name:
Other - Last Name:KIL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 6183
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22403-6183
Mailing Address - Country:US
Mailing Address - Phone:540-361-1740
Mailing Address - Fax:540-374-3102
Practice Address - Street 1:1071 CARE WAY STE 101
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-8431
Practice Address - Country:US
Practice Address - Phone:540-374-3100
Practice Address - Fax:540-374-3102
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049161207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6212271Medicaid
VA6212271Medicaid