Provider Demographics
NPI:1134339328
Name:DR. KIM IERNA KITCHEN, P.C.
Entity type:Organization
Organization Name:DR. KIM IERNA KITCHEN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:IERNA
Authorized Official - Last Name:KITCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-836-7000
Mailing Address - Street 1:500 MONTGOMERY ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-1565
Mailing Address - Country:US
Mailing Address - Phone:703-836-7000
Mailing Address - Fax:703-836-7432
Practice Address - Street 1:500 MONTGOMERY ST
Practice Address - Street 2:SUITE 250
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-1565
Practice Address - Country:US
Practice Address - Phone:703-836-7000
Practice Address - Fax:703-836-7432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401007329122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty