Provider Demographics
NPI:1881860641
Name:KIM, TAE MEE (PHARMD)
Entity Type:Individual
Prefix:
First Name:TAE MEE
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10310 LURIA COMMONS CT # 2F
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-2820
Mailing Address - Country:US
Mailing Address - Phone:703-845-3771
Mailing Address - Fax:703-845-2846
Practice Address - Street 1:6053 LEESBURG PIKE
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-2205
Practice Address - Country:US
Practice Address - Phone:703-845-3771
Practice Address - Fax:703-845-2846
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206538183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist