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DR. KENNETH JAE YOON KIM MD
NPI 1124221924
Pediatrics in Fairfax, VA

Active since June 08, 2007CLIA 49D2086276 · Waiver
3930 PENDER DR, SUITE 330, FAIRFAX, VA 22030(703) 246-0022(703) 246-0080 Get Directions Write a Review

NPPES record last updated: November 11, 2014. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Kenneth Jae Yoon Kim Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. KENNETH JAE YOON KIM MD (NPI 1124221924) is an individual pediatrics provider in Fairfax, Virginia, licensed in Virginia (0101245549) and active in the NPI registry since June 2007. He holds a CLIA Waiver certificate valid through October 29, 2026.

NPPES Registry Identity

NPI1124221924
Entity TypeIndividualMale
Primary Taxonomy208000000X
Provider Legal NameDR. KENNETH JAE YOON KIMCredential: MD
Location Address3930 PENDER DR, SUITE 330Fairfax, VA 22030-0985
Mailing Address3930 Pender Dr, Suite 330Fairfax, VA 22030-0985 · (703) 246-0022 · Fax (703) 246-0080
Phone(703) 246-0022
Fax(703) 246-0080
Sole ProprietorNo
Enumeration DateJune 8, 2007
Last NPPES UpdateNovember 11, 2014
✔ NPI 1124221924 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
License✔ Licensed in VA · 0101245549
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
3930 PENDER DR, Fairfax, VA 22030
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Other Identifiers 1

Medicaid1124221924VA

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 49D2086276

Kenneth J Kim, MD, PC · Fairfax, VA
Active · expires Oct 29, 2026
CLIA Number49D2086276
Laboratory TypePhysician Office
Certificate Effective DateOctober 30, 2024
Certificate Expiration DateOctober 29, 2026
Laboratory DirectorKenneth J. Kim
Laboratory Phone(703) 246-0022
Laboratory LocationKenneth J Kim, MD, PC3930 Pender Dr - Suite 330, Fairfax, VA 22030
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MID ATLANTIC PAIN MANAGEMENT, LLC
Anesthesiology (Pain Medicine)
3930 PENDER DR, SUITE 120
FAIRFAX, VA 22030
Fairfax City (301) 829-7693
SAMAN MADANI DMD & SHADI SHAREGHI DDS PC
Dentist
3930 PENDER DR, SUITE #250
FAIRFAX, VA 22030
Fairfax City (703) 865-5779
AMERICAN ADVANCED DENTAL ASSOCIATES
Clinic/Center (Dental)
3930 PENDER DR, SUITE 110
FAIRFAX, VA 22030
Fairfax City (703) 359-9080
OBGYN OF VIRGINIA, LLC
Obstetrics & Gynecology (Gynecology)
3930 PENDER DR, SUITE 60
FAIRFAX, VA 22030
Fairfax City (571) 249-0717
CENTERS FOR ADVANCED ORTHOPAEDICS, LLC
Orthopaedic Surgery
3930 PENDER DR, SUITE 210
FAIRFAX, VA 22030
Fairfax City (703) 648-3100
DR. LEILA H ZACKRISON M.D.
Internal Medicine (Rheumatology)
3930 PENDER DR, SUITE 280
FAIRFAX, VA 22030
Fairfax City (703) 359-9300
DERMATOLOGY OF VIRGINIA
Dermatology
3930 PENDER DR, SUITE 210
FAIRFAX, VA 22030
Fairfax City (703) 828-7128
ANNA RICH
Hearing Instrument Specialist
3930 PENDER DR, STE 140
FAIRFAX, VA 22030
Fairfax City (571) 432-0640

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kenneth Kim's NPI number?

The NPI number for Kenneth Kim is 1124221924. It was assigned to this individual provider in the NPPES registry on June 8, 2007.

Where is Kenneth Kim located?

Kenneth Kim practices at 3930 Pender Dr Suite 330, Fairfax, VA 22030. The listed phone number is (703) 246-0022.

What is Kenneth Kim's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Does Kenneth Kim hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 49D2086276) is associated with this NPI, valid through October 29, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Kenneth Kim was last updated on November 11, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.