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General NPI Number Information
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NPI Number | 1700960986
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Entity Type | Organization
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Legal Business Name | NORTHERN VIRGINIA BRAIN AND SPINE, INC
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 09/03/2010
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Provider Practice Location Address
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Address Line | 46400 BENEDICT DR SUITE 001
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City | STERLING
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State | VA
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Zip | 20164-6604
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Country | US
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Telephone | 703-437-1160
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Fax | 703-437-1161
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Provider Business Mailing Address
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Address Line | 11654 PLAZA AMERICA DR #528
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City | RESTON
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State | VA
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Zip | 20190-4700
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Country | US
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Telephone | 703-437-1160
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Fax | 703-437-1161
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Authorized Official
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Title or Position | OWNER
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Name | ANJE KIM
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Credential | M.D.
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Telephone | 703-437-1160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 0101239215
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License Number State | VA
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