Provider Demographics
NPI:1780354290
Name:KIM, HAEUN
Entity type:Individual
Prefix:
First Name:HAEUN
Middle Name:
Last Name:KIM
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 1:8308 KINSLEY MILL PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-1728
Mailing Address - Country:US
Mailing Address - Phone:571-294-0567
Mailing Address - Fax:
Practice Address - Street 1:3022 WILLIAMS DR STE 300
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4600
Practice Address - Country:US
Practice Address - Phone:703-573-9800
Practice Address - Fax:703-738-5720
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024180527363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care