Provider Demographics
NPI:1770852386
Name:KIM, HANNA L (PA)
Entity Type:Individual
Prefix:
First Name:HANNA
Middle Name:L
Last Name:KIM
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:3700 JOSEPH SIEWICK DR
Mailing Address - Street 2:SUITE 308
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1744
Mailing Address - Country:US
Mailing Address - Phone:703-698-8960
Mailing Address - Fax:703-641-8427
Practice Address - Street 1:3028 JAVIER RD STE 500
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4622
Practice Address - Country:US
Practice Address - Phone:703-698-8960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-28
Last Update Date:2019-05-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0110003752363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant