Provider Demographics
NPI:1548363740
Name:AMBULATORY ANESTHESIA SERVICES INC
Entity type:Organization
Organization Name:AMBULATORY ANESTHESIA SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-863-8767
Mailing Address - Street 1:10449 WHITE GRANITE DR UNIT 129
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-8005
Mailing Address - Country:US
Mailing Address - Phone:703-863-8767
Mailing Address - Fax:
Practice Address - Street 1:10730 MAIN STREET
Practice Address - Street 2:
Practice Address - City:FAIRFOX
Practice Address - State:VA
Practice Address - Zip Code:22030
Practice Address - Country:US
Practice Address - Phone:301-317-0020
Practice Address - Fax:301-317-0028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2358917OtherAETNA
DC2358917OtherAETNA
VA2358917OtherAETNA
DC9105OtherBLUE SHIELD
VA268616OtherUNITED HEALTH CARE
G00341Medicare ID - Type Unspecified