Provider Demographics
NPI:1043673544
Name:NORTHERN VIRGINIA NEUROLOGY & HEADACHE, PLLC
Entity Type:Organization
Organization Name:NORTHERN VIRGINIA NEUROLOGY & HEADACHE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUNG GOOK
Authorized Official - Middle Name:
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-572-5505
Mailing Address - Street 1:7700 LITTLE RIVER TURNPIKE
Mailing Address - Street 2:SUITE 605
Mailing Address - City:ANNADALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2400
Mailing Address - Country:US
Mailing Address - Phone:509-572-5505
Mailing Address - Fax:
Practice Address - Street 1:7700 LITTLE RIVER TURNPIKE
Practice Address - Street 2:SUITE 605
Practice Address - City:ANNADALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2400
Practice Address - Country:US
Practice Address - Phone:509-572-5505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-01
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty