Provider Demographics
NPI:1013921717
Name:KIM, SUHAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUHAD
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SUHAD
Other - Middle Name:
Other - Last Name:HADAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:21001 SYCOLIN RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-4073
Mailing Address - Country:US
Mailing Address - Phone:703-723-4224
Mailing Address - Fax:
Practice Address - Street 1:21001 SYCOLIN RD
Practice Address - Street 2:SUITE 240
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-4073
Practice Address - Country:US
Practice Address - Phone:703-723-4224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018625122300000X
VA0401413572122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist