Provider Demographics
NPI:1770636508
Name:KIM, CHIN OH (MD)
Entity Type:Individual
Prefix:
First Name:CHIN
Middle Name:OH
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3930 PENDER DR STE 320
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-0986
Mailing Address - Country:US
Mailing Address - Phone:703-817-7770
Mailing Address - Fax:703-563-6274
Practice Address - Street 1:3930 PENDER DR STE 320
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-0986
Practice Address - Country:US
Practice Address - Phone:703-817-7770
Practice Address - Fax:703-563-6274
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2011-08-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101240497207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
9160197OtherCIGNA
352368OtherBCBS