Healthcare Provider Details

I. General information

NPI: 1962243253
Provider Name (Legal Business Name): SOMATUS MEDICAL HOLDINGS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1861 INTERNATIONAL DR STE 600
MC LEAN VA
22102-4420
US

IV. Provider business mailing address

1861 INTERNATIONAL DR STE 600
MC LEAN VA
22102-4420
US

V. Phone/Fax

Practice location:
  • Phone: 571-992-0600
  • Fax:
Mailing address:
  • Phone: 571-992-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. JOE KIMURA
Title or Position: OWNER
Credential: MD
Phone: 571-992-0600