Provider Demographics
NPI:1881649424
Name:MIN, KIHO (MD)
Entity Type:Individual
Prefix:DR
First Name:KIHO
Middle Name:
Last Name:MIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:K
Other - Last Name:MIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8408 ARLINGTON BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4608
Mailing Address - Country:US
Mailing Address - Phone:703-462-8711
Mailing Address - Fax:703-462-8719
Practice Address - Street 1:8408 ARLINGTON BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4608
Practice Address - Country:US
Practice Address - Phone:703-462-8711
Practice Address - Fax:703-462-8719
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101050013207Q00000X, 207R00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA355429OtherANTHEM BLUECROSS BLUESHIELD OF VIRGINIA
VA5606721Medicaid
VAMC12113Medicare PIN
VA5606721Medicaid
VA355429OtherANTHEM BLUECROSS BLUESHIELD OF VIRGINIA