Active NPI
Michael M. Kim, D.D.S.
- Dentist
- Annandale, VA
National Provider Identifier
1306868468
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 0401007750
- Practice address
- 4600 John Marr Dr Ste 302
Annandale, VA 22003-3310 - Phone
- (703) 658-4211
- Fax
- (703) 658-4213
- NPI assigned
- Jul 24, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 0401007750 | VA | Primary |
Addresses
Primary practice location
4600 John Marr Dr Ste 302
Annandale, VA 22003-3310
Mailing address
4600 John Marr Dr Ste 302
Annandale, VA 22003-3310
Phone (703) 658-4211
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0401007750 | VA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153699200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1227052800000",
"number": "1306868468",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4600 JOHN MARR DR STE 302",
"city": "ANNANDALE",
"state": "VA",
"postal_code": "220033310",
"telephone_number": "703-658-4211",
"fax_number": "703-658-4213"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4600 JOHN MARR DR STE 302",
"city": "ANNANDALE",
"state": "VA",
"postal_code": "220033310",
"telephone_number": "703-658-4211",
"fax_number": "703-658-4213"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "MICHAEL",
"middle_name": "M.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-24",
"last_updated": "2008-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "VA",
"license": "0401007750",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Annandale, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.