Provider Demographics
NPI:1942390836
Name:KIM, STEPHEN S (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:S
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 37174
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3174
Mailing Address - Country:US
Mailing Address - Phone:571-423-5699
Mailing Address - Fax:571-423-5698
Practice Address - Street 1:8260 WILLOW OAKS CORPORATE DR STE 400
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4513
Practice Address - Country:US
Practice Address - Phone:703-560-2236
Practice Address - Fax:571-665-6834
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2022-05-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101243334208600000X, 2086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
279750OtherINTERNAL ID-MOTOR VEHICLE ID
WA8390668Medicaid
WA8390668Medicaid
279750OtherINTERNAL ID-MOTOR VEHICLE ID