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General NPI Number Information
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NPI Number | 1770632630
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Entity Type | Organization
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Legal Business Name | NORTHERN VIRGINIA NEPHROLOGY ASSOCIATES PC
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 12/21/2023
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Provider Practice Location Address
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Address Line | 3650 JOSEPH SIEWICK DR STE 310
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City | FAIRFAX
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State | VA
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Zip | 22033-1715
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Country | US
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Telephone | 703-758-8800
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Fax | 703-758-9500
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Provider Business Mailing Address
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Address Line | 10882 MIMOSA PLACE
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City | OAKTON
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State | VA
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Zip | 22124
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Country | US
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Telephone | 703-204-1614
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Fax | 703-204-1826
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. MAGNUS K IKHINMWIN
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Credential | MD
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Telephone | 703-204-1614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 0101057344
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License Number State | VA
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