Provider Demographics
NPI:1821829219
Name:KIM, RHEA (LAC)
Entity type:Individual
Prefix:
First Name:RHEA
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4277 SLEEPY LAKE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2864
Mailing Address - Country:US
Mailing Address - Phone:301-747-5336
Mailing Address - Fax:
Practice Address - Street 1:1493 CHAIN BRIDGE RD STE 202
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-5736
Practice Address - Country:US
Practice Address - Phone:571-332-9860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2024-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121001169171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist