Healthcare Provider Details

I. General information

NPI: 1285557348
Provider Name (Legal Business Name): KEVIN NDEGWA GACHIGUA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24805 PINEBROOK RD STE 312
CHANTILLY VA
20152-4128
US

IV. Provider business mailing address

9414 LANAE LN
MANASSAS PARK VA
20111-8243
US

V. Phone/Fax

Practice location:
  • Phone: 703-496-4371
  • Fax:
Mailing address:
  • Phone: 571-715-6835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: