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General NPI Number Information
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NPI Number | 1770681942
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Entity Type | Individual
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Provider Name | MAGNUS KEHINDE IKHINMWIN MD
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 11/22/2023
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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 PL
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City | OAKTON
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State | VA
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Zip | 22124-2427
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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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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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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