Individual provider Active NPI

Eileen Kim

  • Physician Assistant
  • Falls Church, VA
National Provider Identifier
1063191286
Registry record updated Jul 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
3300 Gallows Rd
Falls Church, VA 22042-3307
Phone
(703) 776-4428
NPI assigned
Jul 14, 2023
Last updated
Jul 14, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 14, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

3300 Gallows Rd
Falls Church, VA 22042-3307

Mailing address

1534 16TH Rd N Apt 5
Arlington, VA 22209-2771

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231026004251 DC Practitioner - Physician Assistant 6406202480 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Inova Health Care Services CurrentSince Sep 18, 2023 Accepting new patients
Inova Health Care Services CurrentSince Sep 18, 2023 Accepting new patients

Locations

3300 Gallows Rd
Falls Church, VA 22042
Phone (703) 352-9395

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1689292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689292800000",
    "number": "1063191286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1534 16TH RD N APT 5",
            "city": "ARLINGTON",
            "state": "VA",
            "postal_code": "222092771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 GALLOWS RD",
            "city": "FALLS CHURCH",
            "state": "VA",
            "postal_code": "220423307",
            "telephone_number": "703-776-4428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "EILEEN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-07-14",
        "last_updated": "2023-07-14",
        "certification_date": "2023-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Falls Church, VA

Sources for this page

Verify at the official NPI Registry.