Provider Demographics
NPI:1427432707
Name:KIM, CLAIRE MINJUNG (DPT)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:MINJUNG
Last Name:KIM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14153 ROBERT PARIS CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-4224
Mailing Address - Country:US
Mailing Address - Phone:703-380-7357
Mailing Address - Fax:703-649-6455
Practice Address - Street 1:14153 ROBERT PARIS CT
Practice Address - Street 2:SUITE A
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-4224
Practice Address - Country:US
Practice Address - Phone:703-380-7357
Practice Address - Fax:703-649-6455
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25530225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1427432707Medicaid