Provider Demographics
NPI:1023569621
Name:KIM, SEONG (MPA)
Entity type:Individual
Prefix:
First Name:SEONG
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 28503
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-2037
Mailing Address - Country:US
Mailing Address - Phone:804-269-8291
Mailing Address - Fax:804-269-8293
Practice Address - Street 1:5000 MONUMENT AVE FL 2
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3627
Practice Address - Country:US
Practice Address - Phone:804-269-8291
Practice Address - Fax:804-269-8293
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110005471363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical