Provider Demographics
NPI:1821357443
Name:KIM, AILEEN CHYN (DDS)
Entity type:Individual
Prefix:DR
First Name:AILEEN
Middle Name:CHYN
Last Name:KIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:AILEEN
Other - Middle Name:
Other - Last Name:CHYN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:5249 DUKE ST
Mailing Address - Street 2:SUITE L-10
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-2926
Mailing Address - Country:US
Mailing Address - Phone:703-823-8812
Mailing Address - Fax:703-823-8813
Practice Address - Street 1:5249 DUKE ST
Practice Address - Street 2:SUITE L-10
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-2926
Practice Address - Country:US
Practice Address - Phone:703-823-8812
Practice Address - Fax:703-823-8813
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401413996122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist