Provider Demographics
NPI:1750726394
Name:DO, KIM-NGAN
Entity type:Individual
Prefix:
First Name:KIM-NGAN
Middle Name:
Last Name:DO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8082 CRESCENT PARK DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-3447
Mailing Address - Country:US
Mailing Address - Phone:571-261-9038
Mailing Address - Fax:571-261-9133
Practice Address - Street 1:8082 CRESCENT PARK DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3447
Practice Address - Country:US
Practice Address - Phone:571-261-9038
Practice Address - Fax:571-261-9133
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-09
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401414229122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist