Provider Demographics
NPI:1821373473
Name:KIM, JAMES PAUL (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:PAUL
Last Name:KIM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8350 TRAFORD LN
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1664
Mailing Address - Country:US
Mailing Address - Phone:703-569-6363
Mailing Address - Fax:703-569-6363
Practice Address - Street 1:8350 TRAFORD LN
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1664
Practice Address - Country:US
Practice Address - Phone:703-569-6363
Practice Address - Fax:703-569-6363
Is Sole Proprietor?:No
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002066152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist