DR. KENNETH JAE YOON KIM MD
NPI 1124221924
Pediatrics in Fairfax, VA
NPI Status: Active since June 08, 2007
Contact Information
3930 PENDER DR
SUITE 330
FAIRFAX, VA
ZIP 22030
Phone: (703) 246-0022
Fax: (703) 246-0080
- Individual
- Male
- Pediatrics
- CLIA Number: 49D2086276
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 10-29-2026
About KENNETH KIM
This page provides the complete NPI Profile along with additional information for Kenneth Kim, a pediatrician established in Fairfax, Virginia with a medical specialization in Pediatrics. The healthcare provider is registered in the NPI registry with number 1124221924 assigned on June 2007. The practitioner's primary taxonomy code is 208000000X with license number 0101245549 (VA). The provider is registered as an individual and his NPI record was last updated 12 years ago.
- NPI
- 1124221924
- Provider Name
- DR. KENNETH JAE YOON KIM MD
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 3930 PENDER DR SUITE 330 FAIRFAX, VA 22030
- Location Phone
- (703) 246-0022
- Location Fax
- (703) 246-0080
- Mailing Address
- 3930 PENDER DR SUITE 330 FAIRFAX, VA 22030
- Mailing Phone
- (703) 246-0022
- Mailing Fax
- (703) 246-0080
- Is Sole Proprietor?
- No
- Enumeration Date
- 06-08-2007
- Last Update Date
- 11-11-2014
- Code Navigator
A pediatrician like Kenneth Kim is a physician who has completed a pediatric residency and is board-certified or board-eligible in a pediatric specialty. Pediatric care providers are trained to care for newborns, infants, children and adolescents. A pediatrician could perform physical exams, manage vaccinations, monitor development milestones, diagnose illnesses, infections, injuries or other health problems, etc.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Pediatrics
- Taxonomy Code
- 208000000X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- 0101245549
- License State
- VA
- Taxonomy Description
- 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.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 1124221924 | MEDICAID (05) | VA |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 49D2086276
- Facility Type
- Physician Office
- Certificate Effective Date
- October 30, 2024
- Certificate Expiration Date
- October 29, 2026
- Laboratory Director
- KENNETH J. KIM
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Kenneth Kim to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1124221924, we treat the final digit (4) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 56. The final step is to find the difference between that total and the next multiple of ten (60 - 56 = 4).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 56 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 20 providers are registered at the same or a nearby location.
FAIRFAX, VA 22030
FAIRFAX, VA 22030
FAIRFAX, VA 22030
FAIRFAX, VA 22030
FAIRFAX, VA 22030
FAIRFAX, VA 22030
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1124221924, enumerated as an "individual" on June 08, 2007.
The provider is located at 3930 PENDER DR SUITE 330 FAIRFAX, VA 22030 and the phone number is (703) 246-0022.
Pediatrics with taxonomy code 208000000X.
The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.
