Active NPI
Kim Sisouk, PHARMD
- Pharmacist
- Falls Church, VA
National Provider Identifier
1841755949
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 0202215342
- Practice address
- 3480 S Jefferson St
Falls Church, VA 22041-3104 - Phone
- (703) 931-1333
- Fax
- (844) 411-6528
- NPI assigned
- Feb 4, 2019
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PH100002630 | DC | |
| Pharmacist | 183500000X | 24641 | MD | |
| Pharmacist | 183500000X | 0202215342 | VA | Primary |
Addresses
Primary practice location
3480 S Jefferson St
Falls Church, VA 22041-3104
Mailing address
6710 Portree CT
Springfield, VA 22152-2933
Phone (707) 217-6997
Other practice location 1
6800 Richmond Hwy
Alexandria, VA 22306-1704
Phone (703) 765-6696
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 |
|---|---|---|---|
| PH100002630 | DC | MD | Pharmacist |
| 0202215342 | VA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Giant of Maryland LLC | Past | Accepting new patients | |
| Giant of Maryland LLC | Past | Accepting new patients |
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 and National Provider Directory roles.
-
dba Giant Pharmacy 760
- Community/Retail Pharmacy
- Alexandria, VA
- NPI 1669405908
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1549238400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604361600000",
"number": "1841755949",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6710 PORTREE CT",
"city": "SPRINGFIELD",
"state": "VA",
"postal_code": "221522933",
"telephone_number": "707-217-6997"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3480 S JEFFERSON ST",
"city": "FALLS CHURCH",
"state": "VA",
"postal_code": "220413104",
"telephone_number": "703-931-1333",
"fax_number": "844-411-6528"
}
],
"practiceLocations": [
{
"address_1": "6800 Richmond Hwy",
"address_purpose": "LOCATION",
"city": "Alexandria",
"state": "VA",
"postal_code": "223061704",
"country_code": "US",
"telephone_number": "703-765-6696",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SISOUK",
"first_name": "KIM",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-02-04",
"last_updated": "2020-11-03",
"certification_date": "2020-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "DC",
"license": "PH100002630",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MD",
"license": "24641",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "VA",
"license": "0202215342",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Falls Church, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.