Michael D Kim MD PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

0101233609 Issued in VA

Legal business name

MICHAEL D KIM MD PC

Doing business as

Fairfax Family Medicine Center

Practice address

10801 Main St
Suite 700
Fairfax, VA 22030-4745

Phone

(703) 591-4100

Fax

(703) 591-5380

NPI assigned

Jun 20, 2006

Last updated

Oct 26, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Michael D Kim, MDNPI 1144291097

Title

President

Phone

(703) 591-4100

Specialties & licenses 1

Addresses

Other identifiers 7

Other names 1

• FAIRFAX FAMILY MEDICINE CENTER Doing business as

Medicare fee-for-service enrollment

Enrolled in DC

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael Donhyun Kim, MD

  • Family Medicine Physician
  • Fairfax, VA
  • NPI 1144291097

  DC

  Medicare reassignment Care Compare group NPD Authorized official
• Juliana Choi, NP

  • Family Nurse Practitioner
  • Fairfax, VA
  • NPI 1336178516

  DC

  Medicare reassignment Care Compare group NPD
• Injung Kim

  • Adult Health Nurse Practitioner
  • Fairfax, VA
  • NPI 1487095311

  DC

  Medicare reassignment NPD
• Surin Rodino

  • Adult Health Nurse Practitioner
  • Springfield, VA
  • NPI 1215280946
  NPD (past)
• Ji Y Choi, NP

  • Family Nurse Practitioner
  • Oceanside, CA
  • NPI 1891207668
  NPD (past)

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

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1256515200000",
    "number": "1609812510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10801 MAIN ST",
            "address_2": "SUITE 700",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220304745",
            "telephone_number": "703-591-4100",
            "fax_number": "703-591-5380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10801 MAIN ST",
            "address_2": "SUITE 700",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220304745",
            "telephone_number": "703-591-4100",
            "fax_number": "703-591-5380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL D KIM MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-20",
        "last_updated": "2009-10-26",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "703-591-4100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101233609",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010002834",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI PPO",
            "identifier": "2110066",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "465828",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PPO",
            "identifier": "7741476",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "3314356",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPPO",
            "identifier": "625622",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST",
            "identifier": "H9840001",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FAIRFAX FAMILY MEDICINE CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Natasha Marie Metzner
• Rachel T Meyer, LCSW
• Georgia Meyers, LPC
• Steven A Meyers, MD
• Osita Mgbendi, DNP- PMHNP
• Michael R. Hryvniak, M.D., P.C.
• Michael S. Chung, M.D., P.C.
• Michael S. Song DDS, PC (FC dental)
• Michael W. Chang, DDS, PLLC (Appalachian Dental)
• Nancy Beth Michael, SLP

• Family Medicine Physician in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Family Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.