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General NPI Number Information
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NPI Number | 1922180488
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Entity Type | Organization
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Legal Business Name | FAIR RIDGE ORTHOPEDICS, INC
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4200 DANIELS AVENUE SUITE 100
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City | ANNANDALE
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State | VA
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Zip | 22003
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Country | US
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Telephone | 703-256-1322
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Fax | 703-256-1325
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Provider Business Mailing Address
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Address Line | 4200 DANIELS AVENUE SUITE 100
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City | ANNANDALE
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State | VA
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Zip | 22003
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Country | US
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Telephone | 703-256-1322
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Fax | 703-256-1325
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Authorized Official
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Title or Position | PRESIDENT
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Name | SEUNG W. PAIK
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Credential |
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Telephone | 703-256-1322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 0101029691
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License Number State | VA
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