Healthcare Provider Details

I. General information

NPI: 1245812825
Provider Name (Legal Business Name): NOVA PAIN MANAGEMENT CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2021
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11240 WAPLES MILL RD STE 300
FAIRFAX VA
22030-6078
US

IV. Provider business mailing address

11240 WAPLES MILL RD STE 300
FAIRFAX VA
22030-6078
US

V. Phone/Fax

Practice location:
  • Phone: 703-752-4623
  • Fax: 703-762-9978
Mailing address:
  • Phone: 703-752-4623
  • Fax: 703-762-9978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SUN LEE
Title or Position: OWNER
Credential:
Phone: 703-296-7695