Provider Demographics
NPI:1912066531
Name:KIM, JOHN HO (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:HO
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:JOON
Other - Middle Name:HO
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:46165 WESTLAKE DR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165
Mailing Address - Country:US
Mailing Address - Phone:703-430-9300
Mailing Address - Fax:703-430-9907
Practice Address - Street 1:46165 WESTLAKE DR
Practice Address - Street 2:SUITE 320
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165
Practice Address - Country:US
Practice Address - Phone:703-430-9300
Practice Address - Fax:703-430-9907
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410706122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist