Provider Demographics
NPI:1770681942
Name:IKHINMWIN, MAGNUS KEHINDE (MD)
Entity Type:Individual
Prefix:DR
First Name:MAGNUS
Middle Name:KEHINDE
Last Name:IKHINMWIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:10882 MIMOSA PL
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-2427
Mailing Address - Country:US
Mailing Address - Phone:703-758-8800
Mailing Address - Fax:703-758-9500
Practice Address - Street 1:3650 JOSEPH SIEWICK DR STE 310
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1715
Practice Address - Country:US
Practice Address - Phone:703-758-8800
Practice Address - Fax:703-758-9500
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057344207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0163520OtherMASS HEALTH
2614802OtherAETNA HMO
VAC08517OtherVA.MEDICARE GROUP
GA08492993AOtherMEDICAID
319481OtherANTHEM
8989317OtherCIGNA
5402030870OtherAARP UNITED HEALTHCARE
VA5856141Medicaid
110228673OtherMEDICARE RAILROAD
279891OtherAMERIGROUP
CA9458135OtherMEDICAID
1121069OtherFIRST HEALTH
F0780001OtherBC CAREFIRST
VA00V069N17OtherVIRGINIA MEDICARE INDIVIDUAL
289502OtherMAMSI
289502OtherALLIANCE PPO
MD212121201OtherMEDICAID
41838OtherGWU HP
5972317OtherAETNA PPO
1121069OtherFIRST HEALTH
5402030870OtherAARP UNITED HEALTHCARE
8989317OtherCIGNA