Provider Demographics
NPI:1699873307
Name:KIM, NANCY CAROL (MD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:CAROL
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1635 N GEORGE MASON DR STE 185
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-3633
Mailing Address - Country:US
Mailing Address - Phone:703-522-7300
Mailing Address - Fax:703-522-0495
Practice Address - Street 1:1635 N GEORGE MASON DR STE 185
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3633
Practice Address - Country:US
Practice Address - Phone:703-522-7300
Practice Address - Fax:703-522-0495
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053952208000000X
FL156444208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G14914Medicare UPIN