Provider Demographics
NPI:1124624390
Name:KIM, MARIA (MS, RDN, LDN)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 MADISON ST STE 3B&3C
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-1764
Mailing Address - Country:US
Mailing Address - Phone:703-988-3475
Mailing Address - Fax:
Practice Address - Street 1:209 MADISON ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-1764
Practice Address - Country:US
Practice Address - Phone:512-596-1705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-11
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered