Healthcare Provider Details

I. General information

NPI: 1720346026
Provider Name (Legal Business Name): REZA KORDESTANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 09/11/2025
Certification Date: 12/26/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 KENMORE AVE STE 220
ALEXANDRIA VA
22304-1306
US

IV. Provider business mailing address

4660 KENMORE AVE STE 220
ALEXANDRIA VA
22304-1306
US

V. Phone/Fax

Practice location:
  • Phone: 703-832-4000
  • Fax: 703-832-4001
Mailing address:
  • Phone: 703-832-4000
  • Fax: 703-832-4001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberMD046008
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: