Provider Demographics
NPI:1073530523
Name:KIM, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10721 MAIN ST STE 304
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6902
Mailing Address - Country:US
Mailing Address - Phone:037-349-4205
Mailing Address - Fax:703-740-3615
Practice Address - Street 1:10721 MAIN ST STE 304
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6902
Practice Address - Country:US
Practice Address - Phone:703-349-4205
Practice Address - Fax:703-349-4205
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234009208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA266870OtherANTHEM
VA010003245Medicaid
VA010003245Medicaid
002117B17Medicare ID - Type Unspecified