Kim, Sandra

Kim, Sandra is an individual health care provider with primary practice located at 4379 Ridgewood Center Dr Ste 102 , Woodbridge VA 22192-8323. She recently has only one registered license in Dental Providers / Dentist, which is considered as her primary health care specialty. Kim, Sandra can be contacted via phone (703) 680-7950.

Contact Information

Primary practice address
4379 Ridgewood Center Dr Ste 102 Woodbridge VA 22192-8323
Phone: (703) 680-7950
Fax: (703) 680-7953
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X 15220 Maryland
Dental Providers / Dentist 122300000X 0401412651 Virginia
Dental Providers / Dentist 122300000X DEN1000804 District of Columbia

Profile Details

NPI number 1114906575
LBN Legal business name Kim, Sandra
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 13th, 2006
Last updated Apr 8th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114906575 NPPES
Indiana MEDICAID 200285280

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