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PETER D KIM MD PC
NPI 1134309685
Family Medicine in Annandale, VA

Active since November 13, 2007CLIA 49D1046109 · Waiver
4208 EVERGREEN LN, SUITE 222, ANNANDALE, VA 22003(703) 642-2288(703) 642-1224 Get Directions Write a Review

NPPES record last updated: January 16, 2014. Verified against the NPPES registry weekly; last sync: October 04, 2026.

About Peter D Kim Md Pc NPPES

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

PETER D KIM MD PC (NPI 1134309685) is a healthcare organization registered as a family medicine in Annandale, Virginia and active in the NPI registry since November 2007. The organization holds a CLIA Waiver certificate valid through September 29, 2027 and lists Peter D Kim, Physician, as its authorized official.

NPPES Registry Identity

NPI1134309685
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NamePETER D KIM MD PC
Location Address4208 EVERGREEN LN, SUITE 222Annandale, VA 22003-3235
Mailing Address4208 Evergreen Ln, Suite 222Annandale, VA 22003-3235 · (703) 642-2288 · Fax (703) 642-1224
Phone(703) 642-2288
Fax(703) 642-1224
Organization SubpartNo
Authorized OfficialPeter D KimPhysician · (703) 642-2288
Enumeration DateNovember 13, 2007
Last NPPES UpdateJanuary 16, 2014
✔ NPI 1134309685 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
4208 EVERGREEN LN, Annandale, VA 22003
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Other Identifiers 1

Medicare PING02179

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

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 49D1046109

Peter D Kim, MD, PC · Annandale, VA
Active · expires Sep 29, 2027
CLIA Number49D1046109
Laboratory TypePhysician Office
Certificate Effective DateSeptember 30, 2025
Certificate Expiration DateSeptember 29, 2027
Laboratory DirectorPeter D. Kim, MD
Laboratory Phone(703) 642-7288
Laboratory LocationPeter D Kim, MD, PC4208 Evergreen Lane - Suite 222, Annandale, VA 22003
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 11

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

ACUPUNCTURE INNAECHUN,INC
Acupuncturist
4208 EVERGREEN LN, SUITE 224
ANNANDALE, VA 22003
Fairfax County (703) 642-3300
HYE SUN LEE
Nurse Practitioner (Family)
4208 EVERGREEN LN
ANNANDALE, VA 22003
Fairfax County (703) 642-2288
CONNIE D. LE, M.D, P.C
Exclusive Provider Organization
4208 EVERGREEN LN, SUITE 214
ANNANDALE, VA 22003
Fairfax County (703) 642-6633
PETER D KIM M.D.
Family Medicine
4208 EVERGREEN LN, SUITE 222
ANNANDALE, VA 22003
Fairfax County (703) 642-2288
BEYOND BEHAVIORS, INC.
Counselor (Mental Health)
4208 EVERGREEN LN, SUITE #211
ANNANDALE, VA 22003
Fairfax County (703) 658-9300
MR. JE UN YOO L.AC,M.AC,DIP'L.AC
Acupuncturist
4208 EVERGREEN LN, SUITE 224
ANNANDALE, VA 22003
Fairfax County (703) 642-3300
DR. JOAN MARIE GONZALEZ MD
Family Medicine
4208 EVERGREEN LN
ANNANDALE, VA 22003
Fairfax County (703) 642-7522
HELEN ROSARIO JARAMILLO GUTIERREZ DE ELLIOTT M.D.
Obstetrics & Gynecology
4208 EVERGREEN LN
ANNANDALE, VA 22003
Fairfax County (703) 642-7522

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 Peter D Kim MD PC's NPI number?

The NPI number for Peter D Kim MD PC is 1134309685. It was assigned to this organization in the NPPES registry on November 13, 2007.

Where is Peter D Kim MD PC located?

Peter D Kim MD PC is located at 4208 Evergreen Ln Suite 222, Annandale, VA 22003. The listed phone number is (703) 642-2288.

What is Peter D Kim MD PC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Peter D Kim MD PC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 49D1046109) is associated with this NPI, valid through September 29, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Peter D Kim MD PC was last updated on January 16, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 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.