Provider Demographics
NPI:1922180488
Name:FAIR RIDGE ORTHOPEDICS, INC
Entity Type:Organization
Organization Name:FAIR RIDGE ORTHOPEDICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SEUNG
Authorized Official - Middle Name:W
Authorized Official - Last Name:PAIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-256-1322
Mailing Address - Street 1:4200 DANIELS AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003
Mailing Address - Country:US
Mailing Address - Phone:703-256-1322
Mailing Address - Fax:703-256-1325
Practice Address - Street 1:4200 DANIELS AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003
Practice Address - Country:US
Practice Address - Phone:703-256-1322
Practice Address - Fax:703-256-1325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101029691207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty