Healthcare Provider Details

I. General information

NPI: 1508443375
Provider Name (Legal Business Name): KIMIA MOMENI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1595 SPRING HILL RD STE 520
VIENNA VA
22182-4101
US

IV. Provider business mailing address

1595 SPRING HILL RD STE 520
VIENNA VA
22182-4101
US

V. Phone/Fax

Practice location:
  • Phone: 703-687-6610
  • Fax: 571-282-3799
Mailing address:
  • Phone: 703-687-6610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number0101289856
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: