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General NPI Number Information
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NPI Number | 1174796445
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Entity Type | Organization
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Legal Business Name | KAVITHA K NAKKA, MD INC.
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Dates
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Enumeration Date | 04/08/2008
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Last Update Date | 09/05/2013
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Provider Practice Location Address
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Address Line | 8301 ARLINGTON BLVD SUITE # T-5
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City | FAIRFAX
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State | VA
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Zip | 22031-2902
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Country | US
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Telephone | 703-560-0404
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Fax |
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Provider Business Mailing Address
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Address Line | 12601 WINTER WREN CT
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City | OAK HILL
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State | VA
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Zip | 20171-1830
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Country | US
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Telephone | 703-560-0404
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | DR. KISHORE K NAKKA
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Credential |
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Telephone | 703-435-1713
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 06068936
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License Number State | VA
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