Healthcare Provider Details

I. General information

NPI: 1215748843
Provider Name (Legal Business Name): EMILY KUZOIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2025
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2970 CHAIN BRIDGE RD
OAKTON VA
22124-3037
US

IV. Provider business mailing address

12202 KYLER LN
HERNDON VA
20171-1624
US

V. Phone/Fax

Practice location:
  • Phone: 703-574-7510
  • Fax:
Mailing address:
  • Phone: 860-463-8613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110010556
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: