{
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"OrgName": "NORTHERN VIRGINIA NEPHROLOGY ASSOCIATES PC",
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"NamePrefix": null,
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"FirstLineMailingAddress": "10882 MIMOSA PLACE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "OAKTON",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "22124",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "703-204-1614",
"MailingAddressFaxNumber": "703-204-1826",
"FirstLinePracticeLocationAddress": "3650 JOSEPH SIEWICK DR STE 310",
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"PracticeLocationAddressCityName": "FAIRFAX",
"PracticeLocationAddressStateName": "VA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "703-758-8800",
"PracticeLocationAddressFaxNumber": "703-758-9500",
"EnumerationDate": "01/09/2007",
"LastUpdateDate": "12/21/2023",
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"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "IKHINMWIN",
"AuthorizedOfficialFirstName": "MAGNUS",
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"AuthorizedOfficialCredential": "MD",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207RN0300X",
"TaxonomyName": "Nephrology Physician",
"LicenseNumber": "0101057344",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}