| Nova Pain Management Center Inc | |
|
11240 Waples Mill Rd Ste 300 Fairfax VA 22030-6078 | |
| (703) 752-4623 | |
| (703) 762-9978 |
| Full Name | Nova Pain Management Center Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 11240 Waples Mill Rd Ste 300, Fairfax, Virginia |
| Authorized Official Name and Position | Sun Lee (OWNER) |
| Authorized Official Contact | 7032967695 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nova Pain Management Center Inc 11240 Waples Mill Rd Ste 300 Fairfax VA 22030-6078 Ph: (703) 752-4623 | Nova Pain Management Center Inc 11240 Waples Mill Rd Ste 300 Fairfax VA 22030-6078 Ph: (703) 752-4623 |
| NPI Number | 1245812825 |
|---|---|
| Provider Enumeration Date | 04/23/2021 |
| Last Update Date | 05/28/2026 |
| Medicare PECOS PAC ID | 3870962517 |
|---|---|
| Medicare Enrollment ID | O20230410000786 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245812825 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | John K Kim |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1053472159 PECOS PAC ID: 2769372085 Enrollment ID: I20040318001265 |
| Provider Name | Yeo Lim Kim |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053923706 PECOS PAC ID: 7618373028 Enrollment ID: I20210910002385 |
| Provider Name | Dantong Xu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184339897 PECOS PAC ID: 4486091154 Enrollment ID: I20240318003099 |
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