Healthcare Provider Details

I. General information

NPI: 1003701277
Provider Name (Legal Business Name): NORTHERN VIRGINIA ORAL AND FACIAL SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2025
Last Update Date: 06/10/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6354 WALKER LN STE 260
ALEXANDRIA VA
22310-3229
US

IV. Provider business mailing address

6354 WALKER LN STE 260
ALEXANDRIA VA
22310-3229
US

V. Phone/Fax

Practice location:
  • Phone: 706-449-8888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: HUY CHI TRINH
Title or Position: OWNER
Credential:
Phone: 703-449-8888