Healthcare Provider Details

I. General information

NPI: 1093075798
Provider Name (Legal Business Name): OPTIMUM CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2012
Last Update Date: 04/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

882 GARRISONVILLE RD
STAFFORD VA
22554-3907
US

IV. Provider business mailing address

9703 CARNOT WAY
VIENNA VA
22182-3013
US

V. Phone/Fax

Practice location:
  • Phone: 540-318-6464
  • Fax:
Mailing address:
  • Phone: 703-888-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: HAMED KABIRI
Title or Position: OWNER
Credential: MD
Phone: 703-888-8100