NPI 1114764107

Spine and Sports Regenerative Medicine Institute

Organisation Interventional Pain Medicine Physician Fairfax, VA

Practice location

Address: 10721 Main St STE 304, Fairfax, VA 22030-6902
Phone: (703) 349-4205
Fax: (703) 349-4205

Authorised official

Name: David Kim
Title: Ceo
Phone: (703) 349-4205

Registered specialties (2)

Interventional Pain Medicine Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 208VP0014X

Other Pain Medicine providers in Virginia →

Pain Medicine Physician

Allopathic & Osteopathic Physicians Taxonomy 208VP0000X

Registry record

NPI: 1114764107
Entity type: Organization
NPI issued: 9 Jul 2024
Record last updated: 16 Jul 2024

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.