Active NPI
Mina Kim, PHARM.D
- Pharmacist
- Fairfax, VA
National Provider Identifier
1639331085
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 0202206676
- Practice address
- 9506 Main St
Fairfax, VA 22031-4031 - Phone
- (703) 425-3575
- Fax
- (703) 425-3639
- NPI assigned
- Jun 26, 2008
- Last updated
- Jun 26, 2008
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 0202206676 | VA | Primary |
Addresses
Primary practice location
9506 Main St
Fairfax, VA 22031-4031
Mailing address
9774 Maitland Loop
Bristow, VA 20136-2576
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0202206676 | VA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eckerd Corporation | Past | Accepting new patients |
Organizations & group practices 1
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.
-
dba Rite Aid Pharmacy 11268
- Community/Retail Pharmacy
- Virginia Beach, VA
- NPI 1982703120
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1214438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214438400000",
"number": "1639331085",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9774 MAITLAND LOOP",
"city": "BRISTOW",
"state": "VA",
"postal_code": "201362576"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9506 MAIN ST",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220314031",
"telephone_number": "703-425-3575",
"fax_number": "703-425-3639"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "MINA",
"credential": "PHARM.D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-06-26",
"last_updated": "2008-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "VA",
"license": "0202206676",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfax, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 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.