Healthcare Provider Details

I. General information

NPI: 1528981230
Provider Name (Legal Business Name): GROWING HEARTS PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3930 PENDER DR STE 330
FAIRFAX VA
22030-0986
US

IV. Provider business mailing address

3930 PENDER DR STE 330
FAIRFAX VA
22030-0986
US

V. Phone/Fax

Practice location:
  • Phone: 703-246-0022
  • Fax: 703-722-8682
Mailing address:
  • Phone: 703-246-0022
  • Fax: 703-722-8682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HOJIN LEE
Title or Position: PRESIDENT
Credential: MD
Phone: 201-616-8535