Provider Demographics
NPI:1780908269
Name:KIM, YOON JA (CMT)
Entity type:Individual
Prefix:MRS
First Name:YOON
Middle Name:JA
Last Name:KIM
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 GUINEA RD
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3926
Mailing Address - Country:US
Mailing Address - Phone:703-930-1226
Mailing Address - Fax:703-537-0174
Practice Address - Street 1:7310 MCWHORTER PL STE D
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-5600
Practice Address - Country:US
Practice Address - Phone:703-333-5121
Practice Address - Fax:703-537-0174
Is Sole Proprietor?:No
Enumeration Date:2010-03-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019003098225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist