Provider Demographics
NPI:1285832535
Name:LANDMARK INTERNAL MEDICINE, LLC
Entity type:Organization
Organization Name:LANDMARK INTERNAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-370-0785
Mailing Address - Street 1:PO BOX 2646
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-0646
Mailing Address - Country:US
Mailing Address - Phone:703-323-0589
Mailing Address - Fax:
Practice Address - Street 1:6300 STEVENSON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-3576
Practice Address - Country:US
Practice Address - Phone:703-370-0778
Practice Address - Fax:703-212-7083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-09
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101230358207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCDA3798OtherRAILROAD MEDICARE
VA00A674105Medicare UPIN