Healthcare Provider Details

I. General information

NPI: 1225046808
Provider Name (Legal Business Name): DOMINIQUE VINH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 TOWN CENTER PKWY
RESTON VA
20190-3204
US

IV. Provider business mailing address

1776 WOODSTEAD CT STE 208
THE WOODLANDS TX
77380-1480
US

V. Phone/Fax

Practice location:
  • Phone: 703-689-9000
  • Fax:
Mailing address:
  • Phone: 877-749-7428
  • Fax: 512-628-3314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberD80204
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2081P0301X
TaxonomyBrain Injury Medicine (Physical Medicine & Rehabilitation) Physician
License Number0101047558
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number0101047558
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number0101047558
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101047558
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: