Provider Demographics
NPI:1396594768
Name:KIMA, VIVA
Entity type:Individual
Prefix:
First Name:VIVA
Middle Name:
Last Name:KIMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4445 CORPORATION LN STE 158
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-3677
Mailing Address - Country:US
Mailing Address - Phone:757-749-3134
Mailing Address - Fax:757-904-5837
Practice Address - Street 1:4445 CORPORATION LN STE 158
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3677
Practice Address - Country:US
Practice Address - Phone:757-749-3134
Practice Address - Fax:757-904-5837
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-0005216374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide