Healthcare Provider Details

I. General information

NPI: 1487441887
Provider Name (Legal Business Name): NAUM PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12600 FAIR LAKES CIR
FAIRFAX VA
22033-4904
US

IV. Provider business mailing address

12600 FAIR LAKES CIR STE 100
FAIRFAX VA
22033-4904
US

V. Phone/Fax

Practice location:
  • Phone: 703-994-4511
  • Fax: 703-994-4787
Mailing address:
  • Phone: 703-994-4511
  • Fax: 703-994-4787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MYOUNG KWAK
Title or Position: OWNER
Credential: MD
Phone: 703-994-4511