Joshua Kim, DO
Individual provider Active NPI Internal Medicine Physician · Centreville, VA
NPI 1679102792 · NPPES record last updated Dec 3, 2024
Key facts
- NPI
- 1679102792
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 0102208669 (VA)
- Practice address
- 6208 Multiplex Dr Ste 150
Centreville, VA 20121-5324 - Phone
- (571) 833-7911
- Fax
- (571) 833-7912
- NPI assigned
- Apr 2, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Internal Medicine
- Education
- Edward Via Col of Osteo Medicine-Carolinas Campus, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Uva Community Health Medical Group LLC
Practice addresses (Care Compare)
6208 Multiplex Dr
Suite 150
Centreville, VA 20121-5324
Phone (571) 833-7911
8700 Sudley Rd
Manassas, VA 20110-4418
Phone (703) 396-5297
Hospital & facility affiliations
- Uva Health Prince William Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in VA, DC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241023004429 | VA | Practitioner - Internal Medicine | 4688098411 | Reassigns benefits to 1 organization |
| I20260605003886 | DC | Practitioner - Internal Medicine | 4688098411 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 515151014352 | MI | MD | Internal Medicine Physician |
| 0102208669 | VA | MD | Internal Medicine Physician |
| 51207R00000X | MI | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Uva Community Health Medical Group, LLC | Current |
Accepting new patients | |
| Uva Community Health Medical Group, LLC | Past | Accepting new patients |
Locations
6208 Multiplex Dr
Ste 150
Centreville, VA 20121
Phone (571) 833-7911
4105 Lewis and Clark Dr
Charlottesvle, VA 22911
8700 Sudley Rd
Manassas, VA 20110
Phone (703) 369-8000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 0102208669 | VA | |
| Pediatrics Physician | 208000000X | 51207R00000X | MI | |
| Internal Medicine Physician | 207R00000X | 0102208669 | VA | Yes |
| Internal Medicine Physician | 207R00000X | 515151014352 | MI |
Addresses
Primary practice location
6208 Multiplex Dr Ste 150
Centreville, VA 20121-5324
Mailing address
PO Box 748613
Atlanta, GA 30384-8613
Phone (434) 295-1000
Other practice location 1
25 Michigan St NE Ste 2100
Grand Rapids, MI 49503-2526
Phone (616) 391-3777
Other providers in Centreville, VA
- Hongki Kim
- Hyojin Kim
- Ie Rae Kim
- Jennifer Carolyn Kim
- Jinse Kim
- Kyung M Kim
- Seok Ju Kim
- Song Jin Sophie Kim
- Thomas S. Kim
- Timothy J Kim
All providers in Centreville, VA · Internal Medicine Physician in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 3, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.